Szypowska Agnieszka, Skórka Agata, Pańkowska Ewa
Department of Diabetology, Neonatology and Birth Defects, Medical University of Warsaw.
Pediatr Endocrinol Diabetes Metab. 2008;14(4):249-51.
Case presentation of hepatic dysfunction after severe ketoacidosis in an infant newly diagnosed with type 1 diabetes mellitus.
A 10-month old Caucasian boy has been admitted to the hospital with pH 6.85, body temperature of 39.9 degrees C and plasma glucose 145 mmol/l. The patient was diagnosed with type 1 diabetes mellitus complicated by diabetic ketoacidosis and otitis media. During the next 48 hours of treatment glucose level and acidosis have normalized. On the 3 day, laboratory tests showed a rapid increase in AST and ALT levels to 8000 IU/L and 6000 IU/L, respectively; INR=2.9. A gradual decrease of transaminase level was observed on the 5 day, while during the next weeks all liver function tests normalized. The patient was recognized with ischemic hepatitis based on abnormal biochemical tests and exclusion of viral infection and hepatotoxic agents.
Diabetic ketoacidosis complicated by hypovolemic shock, infection and profound metabolic decompensation may lead to hypoxic hepatopathy in infants.
新诊断为1型糖尿病的婴儿发生严重酮症酸中毒后肝功能障碍的病例报告。
一名10个月大的白种男孩因pH值6.85、体温39.9摄氏度和血糖145 mmol/L入院。该患者被诊断为1型糖尿病合并糖尿病酮症酸中毒和中耳炎。在接下来48小时的治疗中，血糖水平和酸中毒恢复正常。在第3天，实验室检查显示AST和ALT水平分别迅速升至8000 IU/L和6000 IU/L；国际标准化比值（INR）=2.9。在第5天观察到转氨酶水平逐渐下降，而在接下来的几周内所有肝功能检查均恢复正常。根据异常的生化检查以及排除病毒感染和肝毒性药物，该患者被诊断为缺血性肝炎。
糖尿病酮症酸中毒合并低血容量性休克、感染和严重代谢失代偿可能导致婴儿缺氧性肝病。
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