小儿胰岛素性水肿一例临床病例

C. Liz, Joaquim Cunha, S. Lira
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摘要

胰岛素水肿是一种罕见的疾病,与糖尿病诊断后不久或胰岛素遗漏后血糖控制改善有关。临床表现从轻度水肿到严重的心力衰竭和胸腔积液。诊断为临床,应排除其他水肿原因。由于这是一种自限性疾病,所以没有必要修改胰岛素治疗方案。在更严重的情况下,可能需要利尿剂治疗。临床病例:一名14岁女性因体重增加和腿部肿胀3天进化而被送往急诊室。她在九岁时被诊断出患有1型糖尿病。这名女孩代谢控制不佳,导致多次住院,最后一次住院是在一周前,糖化血红蛋白高于15%。体格检查发现下肢水肿,体重增加7kg。未见颈静脉扩张、肝肿大或其他形式的水肿。女孩血流动力学稳定,利尿在正常范围内。血象、离子图(钠、钾)、肝肾功能检查均正常。尿分析显示有糖尿,胸片未见异常。诊断为胰岛素性水肿,建议限制水和生理盐水,三周后症状完全消失。结论:尽管罕见,临床医生应该意识到这种情况,因为大多数病例不需要改变胰岛素治疗方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insulin-induced edema in a pediatric patient - clinical case
Introduction: Insulin edema is a rare condition associated with improved glycemic control shortly after diabetes diagnosis or following a period of insulin omission. Clinical findings range from mild edema to severe heart failure and pleural effusion. Diagnosis is clinical and other edema causes should be excluded. Since it is a self-limited condition, there is no need to modify insulin regimen. In more severe cases, diuretic therapy may be required.Clinical case: A 14-year-old female was brought to the Emergency Department due to weight gain and leg swelling with three days of evolution. She had been diagnosed with type 1 diabetes at the age of nine. The girl had poor metabolic control which led to multiple hospitalizations, the last one occurring the week before with a glycated hemoglobin higher than 15%. In physical examination, lower limb edema and a 7-kg weight gain were noted. No jugular vein distension, hepatomegaly, or other forms of edema were found. The girl was hemodynamically stable, with diuresis within the normal range. Analytical study consisting of hemogram, ionogram (sodium and potassium), and renal and hepatic function was normal. Urine analysis revealed glycosuria and chest x-ray showed no abnormalities. The diagnosis of insulin-induced edema was established and water and saline restriction recommended, with total symptom resolution three weeks later.Conclusion: Despite rare, clinicians should be aware of this condition, as most cases do not require modifying the insulin regimen.
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