Osuka Akinori, Matsuoka Tetsuya, Idoguchi Koji
Critical Care, Osaka Prefectural Senshu Critical Care Medical Center, Izumisano.
Intern Med. 2009;48(16):1391-5. doi: 10.2169/internalmedicine.48.2236. Epub 2009 Aug 17.
We report a case of diabetic ketoacidosis (DKA) and severe hypertriglyceridemia who developed cardiac arrest due to hypophosphatemia. He was diagnosed with diabetes and hyperlipidemia, indicating metabolic syndrome. Hypophosphatemia was caused by large insulin doses received while treating DKA, which were required because of insulin resistance owing to hypertriglyceridemia. Metabolic syndrome may have accelerated serum phosphate depletion. We suggest frequent monitoring of serum phosphate and phosphate replacement for patients with DKA and severe hypertriglyceridemia. Although such a critical condition has not been reported, it may occur during treatment of patients with poorly controlled type 2 diabetes with DKA.
我们报告一例糖尿病酮症酸中毒（DKA）合并严重高甘油三酯血症患者，该患者因低磷血症发生心脏骤停。他被诊断患有糖尿病和高脂血症，提示代谢综合征。低磷血症是在治疗DKA时因大剂量使用胰岛素所致，而大剂量胰岛素是由于高甘油三酯血症导致的胰岛素抵抗所必需的。代谢综合征可能加速了血清磷酸盐的消耗。我们建议对DKA和严重高甘油三酯血症患者频繁监测血清磷酸盐并补充磷酸盐。尽管尚未报道过如此危急的情况，但在治疗控制不佳的2型糖尿病合并DKA患者时可能会发生。
