[低血糖酮症酸中毒-内分泌急症]。

Deutsche medizinische Wochenschrift (1946) Pub Date : 2025-06-01 Epub Date: 2025-05-19 DOI:10.1055/a-2540-9824
Christina Sieger, Johannes Wolfgang Dietrich
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引用次数: 0

摘要

一名20岁女性患者通过医疗急救服务被送往事故和急诊科。除了肥胖,没有其他已知的健康状况。患者表现为低血压、心动过速、发热、嗜睡和脸色发褐。计算机断层扫描显示弥漫性脑水肿。实验室调查显示炎症生物标志物升高,低钠血症,肾功能衰竭,合并代谢性酸中毒伴严重酮血症和轻微乳酸血症,原发性甲状腺功能减退和肾上腺衰竭。没有糖尿病的适应症。感染源无法确定。急性addison危象在败血症过程中作为自身免疫性多腺综合征(APS) 2型的主要表现。由于最初使用氢化可的松和广谱抗生素、支持措施和左旋甲状腺素(在进一步治疗过程中)治疗,情况可在几天内稳定下来。在没有糖尿病的情况下,饥饿代谢和内分泌疾病的共同作用可导致酮症酸中毒。在这种情况下,应考虑肾上腺衰竭的鉴别诊断。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Hypoglycaemic ketoacidosis - an endocrine emergency].

A 20-year-old female patient was admitted via the medical emergency service to an accident and emergency department. Apart from obesity, no pre-existing medical conditions were known.The patient presented with hypotension, tachycardia, fever, somnolence and a brownish complexion. Computerised tomography revealed a diffuse cerebral oedema. Laboratory investigations demonstrated elevated inflammatory biomarkers, hyponatremia, renal failure, combined metabolic acidosis with severe ketonemia and slight lactatemia, primary hypothyroidism and adrenal failure. No indications for diabetes mellitus were obtained. The source of the infection could not be identified.Acute Addisonian crisis in the course of sepsis as the primary manifestation of autoimmune pluriglandular syndrome (APS) type 2.Due to treatment with initial hydrocortisone and broad-spectrum antibiotics, supportive measures and levothyroxine (in the further course) the situation could be stabilised within several days.The combination of the metabolism of starvation and endocrine diseases can lead to ketoacidosis in the absence of diabetes. The differential diagnosis of adrenal failure should be considered in this situation.

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