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患者,男,34岁,因垂体瘤术后3月,残余肿瘤切除术后46天再次入院拟作放疗。查体:口唇增厚、耳鼻长大、下颌、前额骨和颧骨增大;指、趾粗大。神清合作,视力视野正常。尿糖(一),尿比重:1.015。血糖:4.8mmol/L,血电解质正常。人院后16天睡眠中突然出身四肢抽搐、双眼凝视、呼之不应,考虑继发性癫痫大发作,给予安定10mg iv,继之给予安定20mg静脉滴注,患者逐渐出现深昏迷,血压14/10.5kPa,血糖62.6mmoL/L,血Na~+118mmol/L,血K~+2.84mmol/L,有效渗透压304mosm/L,尿糖卌,尿酮体(?)。血气分析:
The patient, male, 34 years old, had been hospitalized for radiotherapy for 3 months after pituitary tumor surgery and 46 days after the resection of the residual tumor. Physical examination: Thickening of lips, growth of ears and nose, enlargement of jaws, forehead and cheekbones, and thickness of fingers and toes. Shen Qing cooperation, normal vision vision. Urine sugar (a), urine specific gravity: 1.015. Blood glucose: 4.8 mmol/L, normal blood electrolyte. After 16 days of sleep in hospital, he suddenly got limbs twitching, his eyes staring, and he should not call it. Considering secondary epilepsy, giving stability and 10mg iv, followed by a stable infusion of 20mg intravenously, the patient gradually appeared deep coma, blood pressure 14 /10.5kPa, blood glucose 62.6mmoL/L, blood Na~+118mmol/L, blood K~+2.84mmol/L, effective osmotic pressure 304mosm/L, urine glycocalyx, urine ketone body (?). Blood gas analysis: