A Remarkable Elevation in the Procalcitonin Levels Due to Diabetic Ketoacidosis in a Hemodialysis Patient

Procalcitonin (PCT), a marker of the inflammatory response during infections, can be elevated by diabetic ketoacidosis (DKA). A male patient in his 50s with diabetic nephropathy on hemodialysis presented with vomiting and a reduced level of consciousness and was diagnosed with DKA. His PCT level was markedly elevated, but bacterial cultures (blood, urine, and stool) were negative. The PCT level decreased after DKA improvement. In this patient, DKA probably enhanced the PCT levels. As DKA can increase the PCT levels, an elevation of the PCT levels in DKA patients may not be indicative of infectious diseases, and non-infectious causes of DKA should therefore be considered.     

综合急救处理对糖尿病酮症酸中毒患者的应用价值

目的研究急诊综合急救治疗方法在糖尿病酮症酸中毒治疗上的临床价值。方法将2017年3月—2020年3月于该院急诊科接受治疗的100例糖尿病酮症酸中毒患者作为主要对象,用随机数字表法对其分组,各50例。对照组采用急诊常规急救方法,观察组在常规急救基础上使用胰岛素泵治疗,对比两种处理方法的临床疗效。结果相比于对照组,观察组的治疗总有效率更高,差异有统计学意义(P<0.05);观察组治疗后的空腹血糖和餐后2 h血糖均显著低于对照组,差异有统计学意义(P<0.05);观察组的血酮转阴时间、尿酮转阴时间和血糖达标时间更短,差异有统计学意义(P<0.05)。结论对糖尿病酮症酸中毒患者开展综合急救处理更有利于提高救治有效率,可缩短患者的血酮和尿酮转阴时间,使血糖在短时间内达标,优势显著,值得进一步推广应用。     

Impaired cardiac and neurological function with mild hypophosphatemia during insulin therapy for diabetic ketoacidosis and marked improvement with phosphate supplementation: A case report

Insulin treatment for diabetic ketoacidosis occasionally results in hypophosphatemia, which is often mild and does not require treatment. However, we experienced a case in which intravenous insulin administration resulted in myocardial injury and altered consciousness despite mild hypophosphatemia. Phosphate replacement therapy resulted in a marked improvement in symptoms. As overlapping conditions that result in hypophosphatemia can cause severe complications after insulin therapy for diabetic ketoacidosis, even in patients with mild hypophosphatemia, physicians should pay more attention to changes in phosphate levels in patients undergoing treatment for diabetic ketoacidosis.     

酒精性酮症酸中毒的诊疗进展

酒精性酮症酸中毒（alcoholic ketoacidosis,AKA）是指患者在大量饮酒后发生严重呕吐、中断饮食或其他伴发病,从而引起脱水、酮症酸中毒,属代谢系统急症之一。酒精性酮症酸中毒由美国Dillon等于1940年首次提出。酒精中毒患者中大约有10%表现为酒精性酮症酸中毒,多见于肝病和酗酒者,为慢性酒精中毒死亡的主要原因之一。     

Pseudomyocardial infarction and hyperkalemia: A case report and subject review

A case of diabetic ketoacidosis with hyperkalemia and ECG evidence of pseudomyocardial infarction is presented. Electrocardiogram abnormalities resolved shortly after treatment of the elevated potassium. The electrophysiology of hyperkalemia and theories to explain observed ECG changes are discussed. Pseudoinfarction changes that may be peculiar to patients with diabetic ketoncidosis and hyperkalemia are examined.     

糖尿病酮症酸中毒患儿氧化应激状况及影响因素分析

目的 探讨糖尿病酮症酸中毒(DKA)患儿血清氧化应激指标的变化及其与代谢参数的相关性.方法 将受试者分为4组:即DKA组22例;血糖控制一般组18例,糖化血红蛋白(HbAlc)＜9%;血糖控制较差组(HbAlc≥9%)22例;健康对照组36例.检测其血清丙二醛(MDA)、一氧化氮(NO)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)水平,并常规检测空腹血糖、血气、血清离子(K+,Na+,Cl-,P)、肾功能、尿常规、HbAlc.结果 DKA组血清MDA水平显著高于健康对照组(P＜0.01)及血糖控制一般组(P＜0.01),但与血糖控制较差组差异无显著性(P＞0.05);3组糖尿病患儿血清NO水平均显著高于健康对照组(P＜0.01),且血糖控制较差组NO显著高于血糖控制一般组(P＜0.01);3组糖尿病患儿血清GSH-Px水平均显著低于健康对照组(P＜0.01);4组间SOD水平差异无显著性(P＞0.05).相关分析显示糖尿病患儿血清MDA水平与HbAlc呈极显著正相关(r=0.375,P＜0.01),NO与HbAlc呈显著正相关(r=0.250,P＜0.05),DKA患儿血清SOD水平与HbAlc呈显著负相关(r=-0.507,P＜0.05),其他氧化应激指标与代谢参数问无相关性.结论 DKA患儿氧化应激产物显著增加,抗氧化能力降低,这些改变主要应归因于慢性高血糖而不是急性代谢紊乱.     

Hyperglycemic hyperosmolar syndrome at the onset of type 2 diabetes mellitus in an adolescent male

Hyperglycemic hyperosmolar state (HHS) is rare in the paediatric population. The diagnosis and management of HHS presents a challenge in paediatric patients who may present with a mixed picture of HHS and diabetic ketoacidosis (DKA).A 15-year-old obese African American male was brought to the emergency department following a two-day history of feeling unwell. The patient was obtunded, hypotensive and tachypneic. Initial investigations revealed the following: pH 6.97 (normal 7.35 to 7.41), HCO₃⁻ 5 mEq/L (normal 20 mEq/L to 25 mEq/L), glucose 90.9 mmol/L (normal 3.4 mmol/L to 6.3 mmol/L), serum osmolality 454 mOsm/kg (normal 275 mOsm/kg to 295 mOsm/kg), Na⁺ 141 mEq/L (normal 135 mEq/L to 145 mEq/L), corrected Na⁺ 165 mEq/L, K⁺ 8.4 mEq/L (normal 3.5 mEq/L to 5.0 mEq/L), urinalysis revealed 1+ ketones and 4+ glucose. The patient’s clinical course was complicated by severe hyperkalemia, acute renal failure, refractory status epilepticus, rhabdomyolysis, pancreatitis and hypertension.The present case emphasizes the complexity of managing patients with a mixed DKA/HHS presentation and associated morbidities. It is very important to disseminate and implement screening guidelines for type 2 diabetes mellitus, so as to prevent this potentially devastating complication.     

糖尿病酮症酸中毒患者脑脊液酸碱失衡及其代偿机制

目的 :探讨糖尿病酮症酸中毒患者脑脊液 (CSF)酸碱变化及其代偿机制 .方法 :采集分析 15例糖尿病酮症酸中毒患者动脉血和CSF酸碱变量 .结果 :①CSFpH ,PCO2 ,HCO3-均低于正常对照值 (P <0 .0 1) ,同血液一样发生代谢性酸中毒 ;②CSFpH ,PCO2 ,HCO3-较动脉血高 (P <0 .0 1) ,而且相互之间呈显著正相关 ;③CSF酮体较正常对照值高 (P <0 .0 1) ,较动脉血低 (P <0 .0 1) ,且同动脉血酮体显著正相关 ;④CSFHCO3-同CSFPCO2 显著正相关 ,同CSF酮体显著负相关 ;⑤CSFpH同CSFHCO3-显著正相关 ,同CSF酮体显著负相关 .结论 :糖尿病酮症酸中毒时 ,CSF同动脉血一样发生代谢性酸中毒 ,但由于血 脑、血 CSF屏障有抑制血酮体进入CSF的作用及CSFPCO2 相对较高的代偿 ,CSFpH能相对维持在一个接近正常的范围 .如果血酮体明显升高 ,PaCO2 大幅度下降 ,同样可引起CSF严重的代谢性酸中毒     

Hyperglycemic hyperosmolar state and rhino-orbital mucormycosis

Rhino-orbital mucormycosis is a fatal infection. Decompensated diabetes is the most common predisposing factor. Two male adults were admitted because of newly diagnosed diabetes with hyperglycemic hyperosmolar state and CT scan showed extensive pansinusitis and orbital inflammation. Treatment included surgical debridement and antifungal therapy. One patient died from a severe sepsis.