糖尿病酮症酸中毒52例误诊疾病及原因分析

目的 探讨糖尿病酮症酸中毒( diabetic ketoacidosis,DKA)的误诊原因及防范对策,以降低误诊率.方法 回顾性分析我院52例DKA误诊的临床资料.结果 本组27例因呼吸困难、咳嗽、咳痰误诊为肺炎19例,慢性阻塞性肺疾病8例；20例因腹痛、恶心、呕吐误诊为急性胃炎14例,急性胰腺炎4例,急性胆囊炎2例；3例因心慌、胸闷、胸痛误诊为心肌炎2例,心肌梗死1例；2例因意识不清误诊为脑血管意外.52例经实验室检查确诊后均予胰岛素静脉滴注及对症支持治疗.47例好转,5例死亡.结论 DKA患者临床表现复杂,易与呼吸、消化、心血管、神经等多个系统的疾病混淆,临床医生应加强对DKA的认识,及早行血糖、血酮体等检测,以降低误诊率及病死率.

Misdiagnosis Patterns and Cause Analysis of 52 Patients with Diabetic Ketoacidosis

Objective To explore cause of misdiagnosis of diabetic ketoacidosis(DKA) and preventive measures to reduce the misdiagnosis rate.Methods Clincal data of misdragnosed DKA were reviewed.Results 27 patients with breathing difficulty,cough,sputum were misdiagnosed as having pneumonia(19 cases),chronic obstructive pulmonary disease(8 cases).20 cases of abdominal pain,nausea,vomiting,were misdiagnosed as having acute gastritis 14 cases,acute pancreatitis(4 cases),acute cholecystitis(2 cases).3 cases of flustered,bosom frowsty,and chest pain were misdiagnosed as having myocarditis(2 cases),myocardial infarction(1 case).2 cases were misdiagnosed as having cerebrovascular accident.Due to unconsciousness,52 cases identifited by the laboratory tests were given insulin intravenous injection and symptomatic support treatment.47 patients improved,and 5 patients died.Conclusion The clinical manifestations of DKA are complex and easily confused with respiratory,digestive,cardiovascular,neurologic and other diseases.Clinicians should pay greater attention to DKA patients and tests of blood sugar,and blood ketone should be made to reduce the misdiagnosis and mortality rates.