暴发性1型糖尿病合并酮症一例

2018-02-19 佚名 中国糖尿病杂志

患者女,46岁

【一般资料】

患者女,46岁,

【主诉】

主因“多饮、多尿、消瘦1个月,困倦、乏力3d”入院。

【现病史】

患者1个月前无明显诱因出现发热、咽痛,于卫生院诊断为“咽喉炎”,经肌肉注射不明抗生素治疗2d症状缓解,遂外出旅游5d。旅游回来后再次出现发热、咽痛、呕吐、烦渴、多饮、多尿,就诊于天津医科大学第二医院,诊断为“DKA”。纠酮补液及诺和锐30(早晚16、12U)联合倍欣(伏格列波糖三餐时0.2mg)降糖治疗10d,病情好转出院。出院后继续应用在院方案,血糖未正规监测,体重逐渐减轻5kg,7d前自行停用胰岛素,改为不明中药治疗,当日血糖达33.3mmol/L,立即应用胰岛素治疗,餐后血糖15~17mmol/L。近3d无明显诱因出现困倦、乏力、伴右侧腰酸、晨起眼睑水肿,于我院门诊查FPG19.63mmol/L,尿酮体3+,为求全面诊治入院。

【体格检查】

T36.2℃,P78次/min,BP110/80mmHg,BMI20.8kg/m2。甲状腺不大,双肺呼吸音清,未闻及干湿性啰音;R78次/min,律齐;各瓣膜听诊区未闻及病理性杂音;腹软,无压痛、反跳痛;肝脾肋下未触及;Murphy氏征阴性;双下肢无水肿;足背动脉搏动可;跟膝腱反射正常;双侧巴氏征未引出。

【辅助检查】

心脏彩超示主动脉硬化;甲状腺B超、经颅多普勒正常;下肢血管彩超示双下肢动脉各段闭塞性动脉硬化症(无斑块);TG0.55mmoL/L,TC3.8mmoL/L,LDL-C1.9mmoL/L,HbA1c10.3%,果糖胺0.437mmol/L;GADAb、ICA、IAA均阴性。立即补液纠酮,19:00尿酮体转阴,补液量1500ml,小剂量胰岛素静滴共24U,补钾3g。予胰岛素(诺和灵R)强化治疗,30U/D;PPG6~9mmol/L。3d后调整为预混胰岛素诺和锐30,早晚14、12U皮下注射,PPG为13~17mmol/L,FPG为7~9mmol/L。第5天降糖方案改为诺和锐(三餐前6、4、6U)联合来得时(睡前14U)、倍欣(三餐时各0.2mg),PPG8~14mmol/L,FPG6~9mmol/L。患者OGTT结果见表1。


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    2018-02-20 清风拂面

    谢谢分享学习

    0

  3. 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attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Mon Feb 19 16:12:54 CST 2018, time=2018-02-19, status=1, ipAttribution=)]
    2018-02-20 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

  4. 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    2018-02-20 惠映实验室

    学习.谢谢分享.

    0

  5. 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attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Mon Feb 19 16:12:54 CST 2018, time=2018-02-19, status=1, ipAttribution=)]
    2018-02-19 orangesking

    0

  6. 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    2018-02-19 有备才能无患

    T36.2℃.P78次/min.BP110/80mmHg.BMI20.8kg/m2.甲状腺不大.双肺呼吸音清.未闻及干湿性啰音,R78次/min.律齐,各瓣膜听诊区未闻及病理性杂音,腹软.无压痛.反跳痛,肝脾肋下未触及,Murphy氏征阴性,双下肢无水肿,足背动脉搏动可,跟膝腱反射正常,双侧巴氏征未引出

    0

  7. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 19 19:51:58 CST 2018, time=2018-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289207, encodeId=f78028920ed6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Mon Feb 19 17:22:34 CST 2018, time=2018-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289199, encodeId=4d2d2891995a, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Mon Feb 19 16:12:54 CST 2018, time=2018-02-19, status=1, ipAttribution=)]
    2018-02-19 爱吃鱼的菜

    学习了.谢谢分享!

    0

  8. 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    2018-02-19 1e0f8808m18(暂无匿称)

    好病例.学习了.

    0

  9. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Mon Feb 19 19:51:58 CST 2018, time=2018-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289207, encodeId=f78028920ed6, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Mon Feb 19 17:22:34 CST 2018, time=2018-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=289199, encodeId=4d2d2891995a, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/07/a9772c74ffd6edc03a7f9af07b4747f6.jpg, createdBy=b3722138742, createdName=sunfeifeiyang, createdTime=Mon Feb 19 16:12:54 CST 2018, time=2018-02-19, status=1, ipAttribution=)]
    2018-02-19 131****1460

    学习了受益匪浅

    0

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