以急性腹痛为首发表现的糖尿病酮症酸中毒32例误诊分析

Misdiagnosis Analysis of 32 Diabetic Ketoacidosis Patients with Acute Abdominal Pain as the First Manifestation

目的探讨以急性腹痛为首发表现的糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)的误诊原因及防治措施。方法回顾性分析我院2006年9月—2017年3月收治的以急性腹痛为首发表现的32例DKA的临床资料。结果本组均以急性腹痛为首发症状,无糖尿病病史。误诊为肠梗阻12例,胃肠炎10例,阑尾炎8例,胰腺炎2例;误诊时间4 h^2 d;误诊科室为急诊科30例,内、外科各1例。均按误诊疾病予禁食、补液及抗感染等治疗,症状缓解不明显,后行血糖、尿糖等检查,确诊为2型糖尿病并DKA,予补液、补钾、胰岛素静脉泵入等治疗,31例好转出院,1例死于急性肾衰竭。结论以急性腹痛为首发表现的DKA临床易误诊,提高认识、注意鉴别诊断并及时行血糖、尿糖、尿酮等检查是避免或减少误诊的关键。

Objective To investigate misdiagnosed causes and preventive measure of diabetic ketoacidosis （DKA） patients with acute abdominal pain as the first manifestation. Methods Clinical data of 32 DKA patients with acute abdominal pain as the first manifestation was retrospectively analyzed, who were admitted during Septemper 2006 and March 2017. Re-sults All patients were acute abdominal pain as the first symptom without diabetes history. There were 12 patients misdiag-nosed as having intestinal obstruction, 10 patients misdiagnosed as having gastroenteritis, 8 patients misdiagnosed as having appendicitis and 2 patients misdiagnosed as having pancreatitis. The misdiagnosed time was 4 h-2 d. Misdiagnosis depart-ments were 30 patients in emergency department, 1 in internal medicine department and 1 in surgery department. All patients received treatments such as fasting, fluid replacement and anti-infection according to misdiagnosed diseases, but symptoms were not relieved obviously. Type 2 diabetes mellitus combined with DKA was confirmed after checking blood glucose, urine glucose and so on. After treatments such as fluid replacement, kalium replacement and insulin venous pump injection, 31 pa-tients were discharged after conditions were improved, and 1 patient died of acute renal failure. Conclusion DKA patients with acute abdominal pain as the first manifestation are easily misdiagnosed, so clinicians should improve understanding of DKA, and give examinations such as blood glucose, urine glucose and urine ketone in time in order to avoid misdiagnosis.