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本文报告一例少年I型糖尿病酮症酸中毒伴多发性脑血肿和周围神经麻痹的罕见病例。 患者为15岁白人女孩,原不知有糖尿病,因呕吐3日伴进行性昏迷24小时住院,无药物乱用的历史和证据。体检:脱水貌、意识不清、无发热,有痛觉反射。全身肌张力低,腱反射消失,双侧瞳孔等大,光反射存在,视乳头无水肿,无神经定位体征。血压测不出,心率110次/分,其它检查正常。实验检查结果:尿酮体强阳性,血糖22.5mmol/L,尿素氮14.8mmol/L,血白细胞28×10~9/L,代谢性酸中毒,PH6.92。血培养阴性。中心静脉压—9cm水柱。头颅CT及腰穿正常。治疗初始30分钟给生理盐水1升,随后1小时给1升,继之4小时给2升,静脉给胰岛素
This article reports a rare case of juvenile type 1 diabetic ketoacidosis with multiple cerebral hematomas and peripheral nerve paralysis. The patient was a 15-year-old Caucasian girl who had no history of diabetes and was vomited on the 3rd with a coma for 24 hours and had no evidence of drug abuse. Physical examination: dehydration appearance, unconsciousness, no fever, pain reflex. Low body muscle tension, tendon reflex disappeared, bilateral pupils and other large, light reflex exists, no papilledema, no neurological signs. Blood pressure can not be measured, heart rate 110 beats / min, other tests were normal. Experimental results: urine ketone body strongly positive, blood glucose 22.5mmol / L, urea nitrogen 14.8mmol / L, white blood cells 28 × 10 ~ 9 / L, metabolic acidosis, PH6.92. Negative blood culture. Central venous pressure -9cm water column. Head CT and waist wear normally. One liter of normal saline was administered for 30 minutes after initial treatment, followed by 1 liter for 1 hour followed by 2 liters for 4 hours, insulin administered intravenously