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患者女,52岁,因“恶心、呕吐2 d,意识不清8 h”入院。查体:谵妄状态,深大呼吸,R 40/min,BP 132/81 mmHg,HR123/min。全身皮肤粗糙,鼻增宽,口唇肥厚,舌大,下颌增大前突,手足粗大,四肢厥冷。其余未见明显异常。急查血糖39mmol/L,血酮体(+)。动脉血气分析示:pH 6.88,CO_2分压(PaCO_2)2.1 Kpa,氧分压(PaO_2)8.6 Kpa,实际碳酸氢根(AB)3.0 mmol/L,尿素氮(BUN)9.2 mmol/L,K~+4.5 mmol/L,Na~+145 mmol/L。故糖尿病酮症酸中毒(DKA)诊断明确,糖尿病可能继发于垂体生长激素腺瘤(既往病史不详)。入院后以DKA救治方案处理。入院第1日补液量约5500 ml,但24
Female patient, 52 years old, because of “nausea, vomiting 2 d, unconsciousness 8 h ” admission. Examination: delirium, deep breathing, R 40 / min, BP 132/81 mmHg, HR123 / min. Rough skin, nose widening, lip hypertrophy, large tongue, mandibular increased protrusion, syndeach, extremities Jueleng. The remaining no obvious abnormalities. Rapid check blood sugar 39mmol / L, blood ketone body (+). Arterial blood gas analysis showed that pH 6.88, PaCO_2 2.1 Kpa, PaO 2 8.6 Kpa, actual BCO3 3.0 mmol / L, BUN 9.2 mmol / L, K ~ +4.5 mmol / L, Na ~ + 145 mmol / L. Therefore, diabetic ketoacidosis (DKA) diagnosis is clear, diabetes may be secondary to pituitary growth hormone adenoma (history of unknown). Admission to the DKA treatment program. Admission on the first day of about 5500 ml fluid volume, but 24