Concomitant diabetic ketoacidosis and rhinocerebral mucormycosis:report of a case

Mucormycosis is generally an acute and rapidly developing fungal infection. There are at least six distinct clinical varieties, dependent upon the types of predisposing factors of the patient.1 Rhinocerebral mucormycosis most commonly manifests itself in cases of poorly controlled diabetes, especially diabetes with ketoacidosis.2 This clinical report describes a man with diabetic ketoacidosis who developed typical rhinocerebral mucormycosis.     

小鼠胎肝Sca-1+细胞分化为心肌细胞的研究

1临床资料患者男,18岁,因"多饮、多尿伴恶心呕吐3 d,神志模糊1 h"入院.平素体健,家族中无糖尿病史.体格检查:T 37.2℃,P 89次/min,R 22次/min,BP 140/70 mmHg(1 mmHg=0.133 kPa),体质量80kg,身高180 cm,腰围100.5 cm,臀围112.5 cm,腰/臀0.89,BMI 27.77 kg/m2,肥胖体型,神志模糊,心肺腹(一).     

横纹肌溶解综合征误诊为糖尿病酮症酸中毒1例报告及文献复习

目的：分析横纹肌溶解综合征（RM）误诊为糖尿病酮症酸中毒（DKA）的原因,阐明二者引起代谢性酸中毒的机制,提高临床医生对RM和代谢性酸中毒的认识。方法：收集1例以DKA转入本科室后诊断为RM患者的一般情况、临床表现和实验室检查结果,结合国内外文献,分析RM的病因、临床表现、并发急性肾损害（AKI）的治疗方案及预后和本例患者出现RM的病因,探讨RM所致AKI引起的代谢性酸中毒及DKA所致的代谢性酸中毒发生机制和治疗等方面的异同。结果：患者,女性,56岁,因血糖升高15年,乏力、恶心和呕吐4 d入院。查体见患者颜面部水肿,舌质干,皮肤弹性差,心率110 min^-1,四肢重度凹陷性水肿,肌力Ⅳ级。辅助检查提示血清肌酸激酶、肌红蛋白、尿素氮和肌酐水平明显升高,血气分析提示代谢性酸中毒,还存在电解质紊乱及血常规异常。结合病史、症状、体征和各项辅助检查,明确诊断为RM、急性肾衰竭、酸碱平衡失调-代谢性酸中毒并发呼吸性碱中毒及电解质紊乱等,给予大量补液、碱化和保护重要脏器等治疗后,患者临床症状改善,血肌酸激酶、肌红蛋白和肾功能等各项指标较入院时明显好转,预后良好。结论：糖尿病患者可出现多种原因所致的代谢性酸中毒,应注意鉴别。由AKI和DKA所致的代谢性酸中毒在发病机制及治疗上存在差异,临床医生在救治由RM并发AKI所致的代谢性酸中毒时,应尽早给予充足的补液、碱化等有效治疗,以改善患者预后。     

Rhinocerebral mucormycosis: case report

Rhinocerebral mucormycosis is a rare, fulminating opportunistic fungal infection caused by a fungus of the order mucorales. These fungi are ubiquitous, subsisting on decaying vegetation and diverse organic material. Although the fungi and spores of mucorales show minimal intrinsic pathogenicity towards normal persons, they can initiate aggressive and fulminating infection in the immune compromised host. Because rhinocerebral mucormycosis occurs infrequently it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation. We present a patient with classical presentation of rhinocerebral mucormycosis involving the paranasal sinuses, the orbit and cranial base who, was treated by a combination of aggressive surgical and medical therapy and subsequently had surgical repair of the oral defect. The purpose of this presentation is to draw attention to the clinical presentation and pathogenesis of rhinocerebral mucormycosis and to emphasise the need for high index of suspicion in its diagnosis and management.     

糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解1例报告

该文报道1 例糖尿病酮症酸中毒并发纵隔气肿、横纹肌溶解。此患者因糖尿病酮症酸中毒急诊入院,病程中出现纵隔气肿,肌痛伴肌酸激酶、肌酸激酶-MB、血淀粉酶升高,经过积极补液、小剂量胰岛素等处理后病情好转。糖尿病最常见的急性并发症,多出现高血糖、高血酮、脱水、代谢性酸中毒及水电解质紊乱等征候群,但在糖尿病酮症酸中毒的诊治过程中,也需要关注并警惕少见并发症的发生,对于重症糖尿病酮症酸中毒的诊治及预后判断有积极的作用。     

糖尿病酮症酸中毒合并高脂血症性急性胰腺炎1例

糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)是危及生命的严重糖尿病急性并发症之一,由于内源性胰岛素的极度缺乏,DKA可以诱发高脂血症,而严重的高脂血症可诱发急性胰腺炎,即高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)。DKA、HLAP合并发生在临床上较为少见,DKA合并HLAP时,临床表现复杂,其治疗需早期诊断,正确评估,合理降糖。我院曾收治 1 例DKA合并HLAP 患者,临床治疗理想,现结合临床以及相关文献资料分析如下。     

Successful resuscitation in diabetic ketoacidosis: a strong case for the use of bicarbonate

Although severe acidosis is a life-threatening condition owing to its cerebral and cardiac effects, correction of the acidosis with alkali remains a controversial issue in diabetic ketoacidosis. A 22-year-old female patient in diabetic ketoacidosis who was successfully resuscitated after cardiac arrest is presented and a strong case is made for the administration of bicarbonate in severe cases of diabetic ketoacidosis.     

糖尿病酮症酸中毒合并梗阻性肾病1例并文献复习

糖尿病酮症酸中毒是体内胰岛素不足或相对不足而导致的代谢紊乱,从而引起以高血糖、高酮血症和代谢性酸中毒为主要改变的临床综合征,是糖尿病最常见的容易危及生命的急性并发症,治疗上以大量补液、胰岛素降糖、纠正代谢性酸中毒为主要救治方法。本研究报道广东省中医院急诊科收治的1例在糖尿病酮症酸中毒基础上合并梗阻性肾病、急性肾衰竭的患者,由于病情复杂,治疗与单纯糖尿病酮症酸中毒大为不同,通过分析讨论本病例的治疗特点,提示临床需遵循个体化的原则,才能达到精准治疗的目的。     

Severe diabetic ketoacidosis in combination with starvation and anorexia nervosa at onset of type 1 diabetes: A case report

Abstract

We here report a case of diabetic ketoacidosis at onset of type 1 diabetes after a prolonged period of starvation due to anorexia nervosa. A 53-year-old female with a history of anorexia nervosa was admitted to the psychiatric clinic due to psychotic behaviour and inability to take care of herself. Twenty-four hours after admission she was transferred to the clinic of internal medicine due to altered mental status, and laboratory screening revealed a pH of 6.895 and blood glucose concentration of 40 mmol/L. Due to the unusual combination of prolonged starvation and diabetic ketoacidosis we implemented some modifications of existing treatment guidelines and some special considerations regarding nutrition in order to prevent a re-feeding syndrome.     

Spironolactone and diabetic ketoacidosis

The authors describe a diabetic patient on spironolactone who, following a minor surgical procedure, developed ketoacidosis and life-threatening hyperkalaemia.     

Concomitant cerebral and coronary arterial gas emboli in a sport diver: a case report

This report presents a case of concomitant cerebral and coronary gas emboli seen in a sport scuba diver after suffering from pulmonary barotrauma. Except for massive fatal gas embolism, no case of concomitant cerebral and coronary arterial gas emboli has been reported. The 45 year old male diver rapidly surfaced from a depth of 32 feet of sea water and experienced transient loss of consciousness, chest pain, and hemiparesis. EKG and cardiac enzymes suggested myocardial ischemia. He received three recompression treatments and recovered completely.     

Mucormycosis in a diabetic ketoacidosis patient

Oral cavity is considered to be a kaleidoscope for body''s general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.     

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

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。     

疑诊为肺结核的肺毛霉菌病1例

目的 通过报道1例疑诊为肺结核的肺毛霉菌病患者的临床及影像特点,提高对肺毛霉菌病的认识。方法 分析1例疑诊为肺结核的肺毛霉菌病患者的临床特点以及胸部CT表现。结果 51岁男性患者,因少量咯血入院,有糖尿病及冠心病病史,胸部CT示双肺沿支气管分布斑片状实变影,伴树芽征,可见黏液栓征,抗感染治疗病灶增多,纤维支气管镜提示血疑块及白色坏死物堵塞支气管,病理确诊支气管肺毛霉菌病。结论 肺毛霉菌病一般具有基础疾病,症状可表现轻微,临床表现及影像学特点缺乏特异性,易误诊误治,确诊主要靠组织病理检查。     

Necrotizing fasciitis in a female diabetic patient: a case report

Necrotizing fasciitis is a rare, often fatal, soft tissue infection involving any of the layers of soft tissue. Although rare, cases continue to be reported among patients with impariments of the immune system, such as in diabetics. We present the case of a 53-year-old obese, female, diabetic patient who presented to the Emergency Department at United Hospital Center in Clarksburg with necrotizing fasciitis and was subsequently surgically treated.     

以腹痛为主要症状的糖尿病酮症酸中毒1例

1临床资料患者,男,36岁,因反复发作腹痛伴恶心、呕吐2 d,加重2 b而入院。既往“慢性胃炎”病史10年。入院查体:体温36．5℃,脉搏110次／min,呼吸26次／min,血压90／60mmHg(1 mmHg=0．1333 kPa)。呈浅昏迷,面色潮红。