Cağdaş Deniz N, Paç F Ayşenur, Cakal Erman
Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
J Cardiovasc Pharmacol Ther. 2008 Dec;13(4):298-300. doi: 10.1177/1074248408326609.
Glucocorticoids are used as anti-inflammatory agents and are associated with many side effects including hyperglycemia, hypertension, pancreatitis, peptic ulcer, and so on. Hyperglycemia is a common side effect, but ketoacidosis is observed rarely. We present a girl who developed diabetic ketoacidosis after the administration of methylprednisolone during the treatment of acute rheumatic fever. She did not have diabetes and was not obese. She developed ketoacidosis after glucocorticoid therapy. Glucocorticoid-induced insulin resistance, lipolysis, and ketogenesis were likely to have precipitated ketoacidosis. During the treatment of ketoacidosis, the insulin need of the patient was gradually decreased by reducing glucocorticoid dose. In addition to the gradual reduction in glucocorticoid dose, salicylate therapy could be considered the treatment for insulin resistance. In this patient, screening for blood gases and urine was diagnostic in the diagnosis of ketoacidosis. The risk of ketoacidosis as well as hyperglycemia should be considered in the course of glucocorticoid therapy.
糖皮质激素被用作抗炎药，且与许多副作用相关，包括高血糖、高血压、胰腺炎、消化性溃疡等。高血糖是常见的副作用，但酮症酸中毒很少见。我们报告一名在急性风湿热治疗期间使用甲泼尼龙后发生糖尿病酮症酸中毒的女孩。她既往无糖尿病且不肥胖。她在糖皮质激素治疗后发生了酮症酸中毒。糖皮质激素诱导的胰岛素抵抗、脂肪分解和生酮作用可能促成了酮症酸中毒。在酮症酸中毒治疗期间，通过减少糖皮质激素剂量，患者的胰岛素需求量逐渐降低。除了逐渐减少糖皮质激素剂量外，水杨酸盐疗法可被视为治疗胰岛素抵抗的方法。在该患者中，血气和尿液筛查对酮症酸中毒的诊断具有诊断价值。在糖皮质激素治疗过程中应考虑酮症酸中毒以及高血糖的风险。
