腹痛为主诉的糖尿病酮症酸中毒23例临床误诊分析

Analysis of clinical misdiagnosis of 23 cases with diabetic ketoacidosis complained of abdominal pain

目的观察以腹痛为主诉的糖尿病酮症酸中毒(DKA)患者血液生化特性及影像学改变特征,提高对DKA患者的误诊认识。方法回顾性分析本院23例以腹痛为主诉的DKA患者的血生化及影像学资料。结果 23例患者均出现不同程度的血生化改变,20例具有明显的影像学改变,18例具有明显的腹部体征。其中10例误诊为急性胰腺炎,5例误诊为急性胆囊炎,3例误诊为急性阑尾炎,2例误诊为肠梗阻,2例误诊为泌尿系结石,1例误诊为消化道穿孔。所有患者经正规补液、胰岛素降血糖、纠正酸中毒及电解质紊乱等处理后腹痛均缓解并治愈出院。结论以腹痛为主诉的DKA患者常出现明显的血生化及影像学改变,极易与外科腹痛相关的急腹症混淆,误诊率高,临床上应加强认识,全面问诊、系统检查,降低误诊率。

Objective In order to deepen the understanding of misdiagnosis of patients with DKA compained of abdominal pain,the blood biochemical characteristics and imaging features of 23 patients were observed. Methods Retrospective analysis of the blood biochemical characteristics and imaging features of 23 patients with diabetic ketoacidosis compained of abdominal pain. Results Among the 23 patients with DKA compained of abdominal pain,and with varying degrees of blood biochemical changes,there were 20 with obvious changes in imaging and 18 with obvious abdominal signs.10 cases were misdiagnosed as acute pancreatitis,5 cases were misdiagnosed as acute cholecystitis,3 cases were misdiagnosed as acute appendicitis,2 cases were misdiagnosed as intestinal obstruction,2 cases were misdiagnosed as urinary tract stones and 1 case were misdiagnosed as digestive tract perforation.After the treatment of normal fluid replacement,lowering blood glucose by insulin,correction of metabolic acidosis and electrolyte disorder,the abdominal pain of patients was relieved,all patients were cured and left hospital. Conclusion The obvious changes of blood biochemical characteristics and imaging features are often observed in patients with diabetic ketoacidosis compained of abdominal pain,which is very easy to be confused with Surgical Acute Abdomen and has a high misdiagnosis rate. So it is significant to strengthen the clinical understanding of this kind of disease,in addition,comprehensive inquiry and systematic inspection are also needed in order to reduce the misdiagnosis rate.