横纹肌溶解:糖尿病酮症酸中毒的一种罕见且常被遗漏的并发症

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL
Khadijah Oleolo-Ayodeji, Helen Salako, Olaolu Moronkola, E. Oyenusi, A. Oduwole
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引用次数: 0

摘要

1例19岁男性1型糖尿病患者(12岁确诊)因发热和感觉改变被送至急诊室。他对胰岛素治疗方案的依从性值得怀疑。检查显示格拉斯哥昏迷评分为5/15,瞳孔反应迟钝,严重脱水,发烧(体温38.8°C)。生命体征正常上限,导尿管排出暗红色尿,尿量1-2 ml/kg/hr。实验室检查显示高血糖(250 mg/dL),酮症尿(+)血尿(+++)和蛋白尿(++),糖化血红蛋白(HbA1C) - 9.6%。全血细胞计数显示白细胞减少、中性粒细胞增多和血小板减少。紊乱的电解质包括高钠血症、代谢性酸中毒和低磷血症伴尿素和血尿素氮升高。血清肌酐激酶(CK)升高。诊断为糖尿病酮症酸中毒(DKA)合并横纹肌溶解(RM)和颅内压升高,并给予充分的液体复苏、渗透利尿、血糖控制、血小板输注和抗生素治疗,临床改善。3个月后记录正常CK水平。RM是DKA的罕见并发症。应保持高度的怀疑指数,以便及时发现和处理,以防止潜在的并发症,特别是急性肾损伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rhabdomyolysis: A rare and often-missed complication of diabetic ketoacidosis
A 19-year-old male with type 1 diabetes mellitus (diagnosed at 12 years of age) was brought to the emergency room with fever and altered sensorium. His compliance with his insulin regimen was questionable. Examination revealed a Glasgow Coma Scale of 5/15, sluggishly-reacting pupils, severe dehydration, and fever (temperature 38.8°C). Vital signs at the upper limit of normal, urethral catheter drained dark red urine with output of 1–2 ml/kg/hr. Laboratory investigations showed hyperglycemia (250 mg/dL), ketonuria (+) hematuria (+++) and proteinuria (++), and glycated hemoglobin (HbA1C) – 9.6%. Full blood count showed leukopenia, neutrophilia, and thrombocytopenia. Deranged electrolytes included hypernatremia, metabolic acidosis, and hypophosphatemia with elevated urea and blood urea nitrogen. Serum creatinine kinase (CK) was elevated. A diagnosis of diabetic ketoacidosis (DKA) with rhabdomyolysis (RM) and raised intracranial pressure was made and he was managed with adequate fluid resuscitation, osmotic diuresis, glycemic control, platelet transfusion, and antibiotics with clinical improvement. Normal CK levels were documented 3 months later. RM is a rare complication of DKA. High index of suspicion should be maintained for prompt detection and management to prevent potential complications, especially acute kidney injury.
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来源期刊
Journal of Clinical Sciences
Journal of Clinical Sciences MEDICINE, GENERAL & INTERNAL-
自引率
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发文量
15
审稿时长
45 weeks
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