Kawata Hitomi, Inui Daisuke, Ohto Jun, Miki Toyokazu, Suzue Atsuhiko, Fukuta Yasushi, Nishimura Masaji
Emergency and Critical Care Medicine, Tokushima University Hospital, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
J Anesth. 2006;20(2):129-31. doi: 10.1007/s00540-005-0385-2.
A variety of fatal complications are associated with diabetes mellitus. Among these, diabetic ketoacidosis (DKA) figures largely in fatalities in young diabetics. Although hyperosmotic diuresis in DKA causes extreme fluid loss, acute renal failure is less common than expected in DKA. We treated a case of severe DKA with associated coma, acute respiratory failure, and acute renal failure in a 24-year-old man who had been diagnosed with type 1 diabetes mellitus at age 19. The comatose patient had been intubated before transfer to our hospital for intensive care. Despite infusion with isotonic saline and insulin, metabolic acidosis was refractory. On day 2, urine output decreased and pulmonary congestion developed, so we started continuous veno-venous hemodiafiltration (CVVHDF), which was effective against the metabolic acidosis; urine output increased gradually. CVVHDF was withdrawn on day 7, and the patient's renal function recovered completely. He was discharged from the intensive care unit (ICU) on day 14.
糖尿病会引发多种致命并发症。其中，糖尿病酮症酸中毒（DKA）在年轻糖尿病患者的死亡案例中占很大比例。尽管DKA中的高渗性利尿会导致大量体液流失，但DKA中急性肾衰竭的发生率比预期的要低。我们治疗了一名24岁男性患者，他19岁时被诊断为1型糖尿病，此次因严重DKA并发昏迷、急性呼吸衰竭和急性肾衰竭。在转至我院重症监护室之前，昏迷患者已进行了气管插管。尽管输注了等渗盐水和胰岛素，但代谢性酸中毒仍难以纠正。第2天，尿量减少且出现肺淤血，于是我们开始进行连续性静脉-静脉血液透析滤过（CVVHDF），这对代谢性酸中毒有效；尿量逐渐增加。第7天停止CVVHDF，患者肾功能完全恢复。他于第14天从重症监护病房（ICU）出院。
