以消化道症状为主要表现的糖尿病并乳酸性酸中毒二例报告

Analysis of Misdiagnosis and Missed Diagnosis Causes of Lactic Acidosis in Diabetes with Manifestation of Gastrointestinal Symptoms

目的探讨糖尿病并乳酸性酸中毒(lactic acidosis,LA)的早期临床特点、发病机制,分析其误诊原因并提出防范误诊措施。方法回顾性分析我院近期收治的糖尿病并LA 2例的临床资料,并复习相关文献。结果本文例1以腹痛、恶心、呕吐就诊,因血淀粉酶增高误诊为急性胰腺炎;例2以腹泻、呕吐及言语不清就诊,因头颅CT检查示腔隙性脑梗死,初诊脑梗死,漏诊LA。均予相应治疗效果不佳,入我科后经血气分析等检查确诊为糖尿病并LA,予补液、纠酸、机械通气和(或)连续性静脉-静脉血液透析滤过等治疗,临床治愈出院。结论临床医师对糖尿病尤其长期应用双胍类降糖药患者,当出现消化道症状时,应警惕LA可能,常规行血气分析检测,以避免延误诊治。

Objective To explore the clinical feature, pathogenesis of lactic acidosis in diabetes in initial period and to analyze the misdiagnosis causes in order to put forward the preventive measure. Methods Clinical data of 2 patients with lactic acidosis in diabetes misdiagnosed in the primal diagnosis was retrospectively analyzed, and related literature was also re- viewed. Results One patient visited doctors for abdominal pain, nausea and vomiting and another patient for diarrhea, vomi- ting and incomplete aphasia. One patient was misdiagnosed as having acute pancreatitis because of elevated serum amylase; the other patient was primarily diagnosed of cerebral infarction according to the brain computed tomography, which showed that lacunar cerebral infarction was missed lactic acidosis. Corresponding treatment had no significant efficacy. After the two pa- tients were admitted to our department, the blood lactate and arterial blood gas results confirmed the diagnosis of lactic acidosis in diabetes defined. After taking abundant amount of liquids, sodium bicarbonate, mechanical ventilation and the treatment of continuous venovenous hemodiafihration, the two patients were cured. Conclusion Clinicians should improve the awareness of lactic acidosis in diabetes. Patients with diabetes with gastrointestinal symptoms, especially those with long-term use of phenformin anti-diabetic medications should be vigilant about lactic acidosis. Blood lactate examination should be taken regu-larly to prevent misdiagnosis and mistreatment.