他克莫司联合小剂量泼尼松治疗儿童特发性膜性肾病致酮症酸中毒

Ketoacidosis in a boy with idiopathic membranous nephropathy during combined therapy with tacrolimus and low-dose prednisone

1例8岁男性患儿因特发性膜性肾病应用他克莫司（1.25 mg，1次/12 h）联合泼尼松（12.5 mg，隔日1次）口服治疗。5周后，患儿相继出现多饮、多尿、呕吐、嗜睡、脱水征。实验室检查：空腹葡萄糖22.4 mmol/L，动脉血酸碱度7.24，标准碳酸氢盐12 mmol/L，尿酮体（＋＋＋）。诊断为酮症酸中毒。停用他克莫司，给予静脉补液（2125 ml/d）及重组人胰岛素2.5 U/h持续静脉输注。10 h后血酸碱度7.40，空腹葡萄糖8.5 mmol/L，连续2次检测尿酮体均为阴性，改为三餐前皮下注射重组人胰岛素6.25 U。3周后，患儿空腹葡萄糖5.9 mmol/L。

An 8-year-old boy received concomitant treatment with tacrolimus 1. 25 mg every 12 hours and prednisone 12. 5 mg once every other day for idiopathic membranous nephropathy. Five weeks later,the boy developed polydipsia,polyuria,vomiting,somnolence,and dehydration. Laboratory tests showed the following values：fasting plasma glucose 22. 4 mmol/L,blood pH 7. 24,standard bicarbonate 12 mmol/L,and urine ketone bodies（ ＋＋＋）. The patient was diagnosed with ketoacidosis. Tacrolimus was stopped and he was treated with fluid supplementation 2 125 ml/d and continuous IV infusion of recombinant human insulin 2. 5 U/h. After 10 hours,laboratory results indicated that blood pH was 7. 40,fasting plasma glucose was 8. 5 mmol/L,and detection of urine ketone was negative for two times in a row. Then,his treatment was switched to subcutaneous injection of recombinant human insulin 6. 25 U before three meals. After 3 weeks,the fasting plasma glucose was 5. 9 mmol/L.