糖尿病高渗性非酮症昏迷并发横纹肌溶解1例报道

糖尿病高渗性非酮症昏迷（HHS）是糖尿病最为常见急性代谢紊乱状态,死亡率10％～50％。而横纹肌溶解症（RM）的发生常伴有威胁生命的代谢紊乱和急性肾功能衰竭等一系列并发症,研究显示,RM的病死率在3％～27％。近年来,有关HHS并发RM的临床病例有一些报道,并因病情凶险,预后差,引起重视,现将我院诊治1例糖尿病高渗性非酮症昏迷并发横纹肌溶解临床资料进行分析。     

老年糖尿病性非酮症性高渗昏迷合并横纹肌溶解症1例报道

糖尿病性非酮症性高渗昏迷（nonketotic hyperosmolar diabetic coma,NHDC）是糖尿病严重急性并发症之一,病死率较高,可达10%-50%,多见于老年病人。横纹肌溶解综合征（rhabdomyolysis,RM）是指一系列影响横纹肌细胞膜、膜通道及能量供应的多种遗传性或获得性疾病导致的横纹肌损伤,细胞膜完整性遭到破坏,细胞内容物包括肌红蛋白.     

糖尿病非酮症高渗综合征合并横纹肌溶解症一例

1974年Grossman等报道糖尿病非酮症高渗综合征（DNHS）与横纹肌溶解症（RM）有关。国内报道罕见，现报道一例如下.     

糖尿病非酮症高渗性昏迷并横纹肌溶解症一例

患者,男,40岁.2006年11月26日因"多饮、多尿半月,乏力两天,突发神志不清2小时"至急诊,不伴有肢体抽搐、二便失禁.查体:中度昏迷,体温39.4℃,血压66/32 mm Hg,心率105次/分,呼吸22次/分.     

糖尿病急性代谢并发症与非创伤性横纹肌溶解症

糖尿病酮症酸中毒（DKA）与高渗性高血糖状态（HHS）是糖尿病最为严重的急性代谢并发症,在DKA或HHS患者中有50%可合并非创伤性横纹肌溶解症（NRML）,严重者可导致急性肾功能衰竭。DKA或HHS介导NRML的机制可能包括肌肉缺血、缺氧,电解质紊乱及酸碱失衡,感染,应用羟甲戊二酸单酰CoA还原酶抑制剂等。因早期诊断并及时治疗常可逆转病情发展,从而避免发生严重并发症,降低死亡率,因此对NRML及时并准确的诊断很重要。     

高渗性非酮症糖尿病昏迷

高渗性非酮症糖尿病昏迷早在19世纪末20世纪初就有零星报告。1957年有人称之为非酮症严重糖尿病木僵综合征(Syndrome of severe diabetic stupor without ketosis),近些年来诊断病例数逐渐增多,约占严重糖尿病症的10～20%。几乎是成年糖尿病尤其是老年糖尿病特有的并发症,临床表现有口渴多尿,脱水,进行性精神障碍以至昏迷,血糖达33.3mmol/L(600mg/dl)以上,有的报告达26.6mmol/L(4800mg/dl)。血钠高达145mmol/L。血渗透压350 mmol/升。尿酮体阴性或弱阳性,酸中毒不明显。渗透性利尿而可导致严重失水、休克。心血管系统有较多严重并发症,如心肌梗塞,心律失常等;有时肾功能衰     

高渗性非酮症性糖尿病昏迷15例临床分析

高渗性非酮症性糖尿病昏迷１５例临床分析青岛建筑职工医院（２６６０００）张幼君，徐晓妹，兰巧玲，邵廷亮１９８５～１９９５年，我院收治高渗性非酮症性糖尿病昏迷（ＨＮＤＣ）患者１５例。现作以下分析，并就降低其病死率问题进行讨论。１资料分析本组男９例，女６例...     

高渗性非酮症糖尿病昏迷

高渗性非酮症糖尿病昏迷福建省立医院福建３５０００１林丽香高渗性非酮症糖尿病昏迷（Ｈｙｐｅｒｏｓｍｏｌａｒｎｏｎｋｅｔｏｔｉｃｄｉａｂｅｔｉｃｃｏｍａ，ＨＮＤＣ）是糖尿病的急性并发症之一。据国内外报道，此组患者约２／３在６０岁以上，但也有报告发生在１８...     

Bilateral renal malakoplakia with acute renal failure: a case report and literature review

Malakoplakia involving the genitourinary tract is a rare inflammatory disorder that presents a diagnostic challenge. Renal parenchymal involvement is particularly uncommon. We report a case of bilateral renal malakoplakia that presented with acute renal failure and simulated xanthogranulomatous pyelonephritis (XGP). The etiology, clinical course, and management of malakoplakia are reviewed, emphasizing the distinct characteristics of the disease that lead to its accurate diagnosis.     

Severe raltegravir-associated rhabdomyolysis: a case report and review of the literature

Raltegravir (RAL), an HIV integrase inhibitor, may uncommonly induce an increase of serum creatine kinase (CK) both in na?ve and antiretroviral (ARV)-experienced HIV-positive patients. We report the case of severe rhabdomyolysis requiring hospitalization in an ARV-experienced HIV/hepatitis C co-infected patient treated with a RAL-containing drug regimen. Factors favouring a severe clinical occurrence of RAL-induced rhabdomyolysis from cases reported in literature are described.     

慢性肾衰竭合并结核性胸膜炎1例附文献复习

目的 提高对肾脏疾病并发结核的认识。方法对1例经病原学检查确诊为结核性胸膜炎的慢性肾衰竭患者的临床资料进行分析，并结合文献复习，结果肾脏疾病并发结核并非罕见。结核感染既可引起肾脏损害，亦可发生存原有肾脏疾病基础上。肾脏疾病并发结核时，诊断较为困难，常需反复取样送检才能明确。结论在对肾脏疾病进行诊治过程中．需提高对结核的警惕性。     

Metabolic alkalosis in diabetic ketosis: a case report

A mixed metabolic alkalosis and metabolic acidosis, resulting in an alkalemic state, occurred in a hyperlipemic patient with previously diagnosed non insulin dependent diabetes. The metabolic alkalosis, due to large loss of gastric HCl, was more severe than the diabetic acidosis and resulted in an alkaline blood pH. Initially the metabolic acidosis was due to ketoacidosis and coexistent lactic acidosis. During the improvement of the alkalemic and hyperglycemic state, lactic acidosis disappeared but a paradoxical rise of plasma NEFA and ketone body concentrations supervened so that the high anion gap metabolic acidosis was virtually unchanged. The rise of plasma NEFA was probably related to the marked removal of plasma triglycerides, by insulin activation of lipoprotein lipase, and consequent saturation of the pathways of fatty acid incorporation into adipose tissue.