Gale E A, Tattersall R B
Br Med J. 1978 Nov 18;2(6149):1387-9. doi: 10.1136/bmj.2.6149.1387.
During 1969-77, 20 episodes of severe hypothermia occurred in 19 diabetic patients in Nottingham. Thirteen were associated with ketotic hyperosmolar coma, two with lactic acidosis, and one with hypoglycaemia, while in four there was no loss of diabetic control. Ketoacidosis accounted for 11.8% of all admissions for severe accidental hypothermia and was a commoner cause than hypothyroidism (8%). Patients with ketoacidosis were younger and developed hypothermia as often during the summer as during the winter. The metabolic disturbance was characteristic, with severe acidosis (mean pH 7.04), a high blood glucose concentration (mean 56.6 mmol/l; 1020 mg/100 ml), and high plasma osmolality (mean 379.7 mmol (mosmol)/kg). Eight of the 13 episodes proved fatal. Hypothermia may aggravate ketoacidosis and complicate treatment and should be sought in all patients with severe diabetic coma.
1969年至1977年间，诺丁汉的19名糖尿病患者发生了20次严重体温过低。其中13次与酮症高渗性昏迷有关，2次与乳酸性酸中毒有关，1次与低血糖有关，而4次血糖控制未出现紊乱。酮症酸中毒占所有严重意外低温入院病例的11.8%，是比甲状腺功能减退症（8%）更常见的病因。酮症酸中毒患者较年轻，夏季和冬季发生体温过低的频率相同。代谢紊乱具有特征性，表现为严重酸中毒（平均pH值7.04）、高血糖浓度（平均56.6 mmol/l；1020 mg/100 ml）和高血浆渗透压（平均379.7 mmol（毫渗摩尔）/kg）。13次发作中有8次被证明是致命的。体温过低可能会加重酮症酸中毒并使治疗复杂化，所有严重糖尿病昏迷患者都应检查是否存在体温过低。
