糖尿病酮症酸中毒并发高血糖高渗状态致多器官障碍综合征1例报告及文献复习

Multiple organ dysfunction syndrome caused by diabetic ketoacidosis combined with hyperglycemic hyperosmolar state:A case report and literature review

目的:分析糖尿病酮症酸中毒(DKA)并发高血糖高渗状态(HHS)致脑水肿、急性心肌损伤、急性肾损伤和横纹肌溶解等并发症患者的临床诊治方法,以提高临床医生对DKA并发HHS致多器官障碍综合征(MODS)的认识。方法:收集1例DKA并发HHS致MODS患者的临床资料,并结合文献复习,分析该病例的诊断和治疗方法。结果:患者,女性,26岁,否认糖尿病病史,因“食欲差、心悸1个月,恶心、呕吐3 d,加重伴意识不清3 h”入院。患者主要临床表现为休克、HHS、酮症酸中毒、脑水肿、急性心肌损伤、急性肾损伤和横纹肌溶解等并发症;诊断为DKA并发HHS和MODS,给予补液、降糖、血液净化和保护脏器等治疗,患者生命体征稳定、脏器功能好转出院。出院6个月后电话随访,血糖和脏器功能正常。结论:DKA并发HHS,起病凶险,预后差,尤其对于青年患者,做好早期诊断以及预防极其重要,一旦发生MODS及时就诊重症医学科是减少死亡和改善预后的关键。

Objective:To analyze the clinical diagnosis and treatment of the patient with brain edema,acute myocardial injury,acute liver injury,rhabdomyolysis and other complications caused by diabetic ketoacidosis(DKA)combined with hyperglycemic hyperosmolar state(HHS),and to improve the clinicians’understanding of the multiple organ dysfunction syndrome caused by DKA combined with HHS.Methods:The clinical materials of a patient with DKA combined with HHS were collected,and the relevant literatures were reviewed;the diagnosis and treatment methods of the disease were analyzed.Results:A female 26-year-old patient was admitted to hospital because of“poor appetite,palpitation for 1 month,nausea and vomiting for 3 d,aggravation with unconsciousness for 3 h”.The main clinical manifestations of the patient were shock,HHS,ketoacidosis,brain edema,acute myocardial injury,acute kidney injury,rhabdomyolysis and so on;the diagnosis was DKA complicated HHS and MODS.The patient was treated with fluid resuscitation,insulin,blood purification,organ protection.After that,the patient’s vital signs were stable and the organ functions were improved,the patient was discharged.The telephone follow-up 6 months after discharge showed that blood glucose and organ function were normal.Conclusion:DKA complicated with HHS is vital sign of poor prognosis,especially in the younger patients.In case of MODS,early diagnosis and prevention is the key to reduce death and improve prognosis.