胰岛素自身免疫综合征的超高龄患者发生高渗糖尿病昏迷1例诊治体会

Experience in diagnosis and treatment of hyperosmotic diabetic coma in an over-aged patient with insulin autoimmune syndrome

高渗糖尿病昏迷是糖尿病患者严重急性并发症,致死性较高,早期鉴别、明确诊断、积极治疗极为重要。治疗主要包括积极补液,纠正脱水;小剂量胰岛素静脉输注控制血糖;纠正水、电解质和酸碱失衡;抗凝治疗;去除诱因和治疗并发症等。然而对于超高龄胰岛素自身免疫综合征的老年患者,在补液及胰岛素应用上都有很大的限制。本病例通过个体化补液方案、小量激素加胰岛素的治疗方法,同时进行了抗凝抗感染等对症处理,使患者转危为安,对临床工作有重要的借鉴经验。

Hyperosmotic diabetic coma(HDC)is a severe and acute complication of diabetes with high fatality,so the early identification and diagnosis and active treatment are of great importance for HDC patients.The treatment for HDC patients mainly includes the active rehydration,correction of dehydration,intravenous infusion of low-dose insulin to control blood glucose,correction of imbalance among water,electrolyte and acid-base,anticoagulation therapy,removal of inducement and treatment of complications.However,for the over-aged patients with insulin autoimmune syndrome,there were restrictions on rehydration and insulin application.This case was treated with individualized rehydration scheme,a small amount of hormone plus insulin,and symptomatic treatment such as anticoagulation and anti-infection,thereby obtaining ideal efficacy,which can be used as an impor tant reference for clinical work.