新冠肺炎诱发糖尿病酮症酸中毒1例

EMJ Diabetes Pub Date : 2022-05-16 DOI:10.33590/emj/21-00125
P. Paramanathan, Muhammad Abbas
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摘要

糖尿病紧急情况,如糖尿病酮症酸中毒(DKA)是危及生命的并发症,通常由感染或疾病(如COVID-19)引发。病例介绍:一名55岁非裔美国女性向其初级保健医生就诊,主诉疲劳、脱水、食欲减退、嗜睡和体重突然减轻,既往有2型糖尿病病史。葡萄糖水平>15 mmol/L,酮水平>16 mmol/L;他们立即被送到急诊科进行DKA评估。在那里,这名患者的COVID-19检测呈阳性。他们的葡萄糖水平为361 mg/dL, pH值为7.11,碳酸氢盐水平为10 mEq/L,钠水平为125 mEq/L,钾水平为3.9 mEq/L,氯化物水平为95 mEq/L,阴离子间隙为20,酮阳性水平。在接下来的几天里,病人的病情恶化了;胸部CT示双侧肺中、下叶磨玻璃影伴实变,小叶间隔增厚,符合非典型感染、呼吸窘迫和肺炎。在接下来的几周内,患者接受静脉输液、胰岛素治疗和经验性抗生素治疗,最终康复。讨论:在covid -19背景下,促使糖尿病患者发生DKA的因素有:应激激素分泌增加,可抵消胰岛素的作用并升高血糖水平,以及严重急性呼吸综合征冠状病毒2与人体细胞相互作用的方式,导致胰岛细胞损伤。结论:糖尿病和COVID-19患者的并发症相互加剧。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diabetic Ketoacidosis Precipitated by COVID-19: A Case Report
Introduction: Diabetic emergencies such as diabetic ketoacidosis (DKA) are life-threatening complications, often precipitated by infections or illnesses such as COVID-19. Case presentation: A 55-year-old African American female presented to their primary care physician, complaining of fatigue, dehydration, decreased appetite, hypersomnia, and sudden weight loss, and a past medical history of Type 2 diabetes. They had a glucose level of >15 mmol/L and ketone level of >16 mmol/L; they were immediately sent to the emergency department for assessment of DKA. There, the patient tested positive for COVID-19. They had a glucose level of 361 mg/dL, a pH of 7.11, a bicarbonate level of 10 mEq/L, a sodium level of 125 mEq/L, a potassium level of 3.9 mEq/L, a chloride level of 95 mEq/L, an anion gap of 20, and a positive ketone level. Over the next few days, the patient’s condition got worse; their chest CT scan showed ground-glass opacities with consolidations in the middle and inferior lobes of the lungs bilaterally, along with interlobular septal thickening, which are consistent with an atypical infection, respiratory distress, and pneumonia. The patient was on intravenous fluids, insulin therapy and empirical antibiotics for the next few weeks, and eventually recovered. Discussion: Factors precipitating DKA in patients with diabetes in the setting of COVID-19are: the increased secretions of stress hormones that counter the effects of insulin and increase blood glucose levels, and the ways in which severe acute respiratory syndrome coronavirus 2 interacts with human cells, leading to pancreatic islet cell damage. Conclusion: Diabetes and COVID-19 intensify each other’s complications in patients diagnosed with both.
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