高渗高血糖综合征并糖尿病酮症酸中毒病例分析

A Case Report Study of Hyperglycemic Hyperosmolar Syndrome Combined with Diabetic Ketoacidosis

病史:患者男性,52岁,因“乏力、纳差3天”入院。患者于3天前无诱因出现乏力、纳差,伴上腹部阵发性隐痛,无腹泻、呕吐,入院查随机血糖达90.2 mmol/L,β-羟丁酸6.42 mmol/L,血气分析示PH值7.068,肾功能示:尿素氮42.3 mmol/L,肌酐648 μmol/L,有效血浆渗透压371.84 mOsm/L。体征:P:103次/分,R:22次/分,BP:127/87 mmHg,皮肤干燥,舟状腹。诊断:高渗高血糖综合征,糖尿病酮症酸中毒,急性肾损伤,急性心肌损伤。治疗:予大量补液、小剂量胰岛素降糖消酮治疗。转归:患者高渗及酸中毒纠正,肾功能正常,改为皮下注射胰岛素降糖治疗。

History: A 52-year-old male patient was admitted with “fatigue and anorexia for 3 days”. Three days ago, the patient presented with fatigue and anorexia without inductance, accompanied by parox-ysmal pain in the upper abdomen, without diarrhea and vomiting. The random blood glucose was 90.2 mmol/L, β-hydroxybutyric acid was 6.42 mmol/L, blood gas analysis showed PH 7.068, and renal function showed urea nitrogen 42.3 mmol/L. Creatinine was 648 μmol/L, and the effective plasma osmolality was 371.84 mOsm/L. Signs: P: 103 beats/min, R: 22 beats/min, BP: 127/87 mmHg, dry skin, navicular abdomen. Diagnosis: hypertonic hyperglycemic syndrome, diabetic ke-toacidosis, acute kidney injury, acute myocardial injury. Treatment: A large amount of fluid re-placement and a small dose of insulin were given to reduce blood sugar and ketone. Outcome: The patient's hyperosmolar and acidosis were corrected, renal function was normal, and hypoglycemic treatment was changed to subcutaneous insulin injection.