糖尿病酮症酸中毒合并低磷血症、烟曲霉菌肺炎一例并文献复习

Diabetic ketoacidosis complicated with hypophosphatemia and Aspergillus fumigatus pneumonia:a case report and literature review

目的探讨糖尿病酮症酸中毒(DKA)合并肺部感染患者发生低磷血症的临床特点。方法报道1例DKA合并重度低磷血症、烟曲霉菌肺炎的35岁男性病例。以中英文“糖尿病酮症酸中毒”“低磷血症”为检索词对以下数据库进行检索:PubMed、中国知网、万方数据知识服务平台、维普中文科技期刊数据库,收集并分析检索到的DKA合并低磷血症病例的资料。结果该例为35岁初诊糖尿病的男性患者,并发DKA、烟曲霉菌肺炎以及重度低磷血症,予补液、降糖、抗真菌治疗后,血磷水平也随着DKA纠正、肺部感染控制而自行恢复正常,患者好转出院。复习文献共检索到具有较完整临床资料的DKA合并低磷血症病例16例,临床表现包括:呼吸衰竭、横纹肌溶解、癫痫发作、心脏骤停、疲劳、无症状等。部分患者可自行恢复,但部分患者仍需接受补磷治疗。结论DKA合并肺部感染患者易发生低磷血症,临床表现无特异性,严重时可危及生命,早期识别有助于改善预后。

Objective To investigate the clinical characteristics of hypophosphatemia in diabetic ketoacidosis(DKA)complicated with pulmonary infection.Methods A patient with DKA complicated with Aspergillus fumigatus pneumonia who developed severe hypophosphatemia was reported.Revelant studies were searched from PubMed,CNKI,Wanfang Data and Chongqing VIP using“diabetic ketoacidosis”and“hypophosphatemia”as the keywords.Clinical data of retrieved cases of DKA complicated with hypophosphatemia were collected and analyzed.Results The 35-year-old male patient were diagnosed with diabetes mellitus complicated with DKA,Aspergillus fumigatus pneumonia and severe hypophosphatemia.After fluid rehydration,hypoglycemic and antifungal treatment,serum phosphorus level was restored to normal range spontaneously along with DKA correction and pulmonary infection control.The patient was discharged after improvement.According to literature review,16 cases of DKA complicated with hypophosphatemia with complete clinical data were searched.Clinical manifestations mainly include respiratory failure,rhabdomyolysis,seizures,cardiac arrest,fatigue,and no symptoms,etc.Some patients can spontaneously recover,whereas other patients require supplemental phosphorus therapy.Conclusions DKA patients complicated with pulmonary infection are prone to hypophosphatemia with non-specific clinical manifestations,which can be life-threatening in severe cases.Early recognition is helpful to improve clinical prognosis.