Makdsi Fadi, Kolade Victor O
Department of Internal Medicine, University of Tennessee College of Medicine 975 East Third Street, Box 94, Chattanooga, TN 37403 USA.
Cases J. 2009 Sep 9;2:8095. doi: 10.4076/1757-1626-2-8095.
An 18-year-old male with type 1 diabetes mellitus presented to the emergency department after one day of lethargy and vomiting. Physical examination revealed a dehydrated male with tachycardia and Kussmaul's respiration. There was subcutaneous emphysema in both supraclavicular regions. Chest auscultation revealed a positive Hamman's sign. Laboratory investigation was significant for metabolic acidosis with venous blood pH 7.08. Plasma glucose was 1438 mg/dl; ketones were present in the urine. Chest X-ray showed subcutaneous emphysema and pneumomediastinum, which resolved spontaneously within 72 hours of initiation of treatment for diabetic ketoacidosis.Pneumomediastinum is an uncommon complication of diabetic ketoacidosis. Recognizing that severe diabetic ketoacidosis may cause pneumomediastinum allows for expedient management.
一名18岁1型糖尿病男性患者，在出现嗜睡和呕吐一天后就诊于急诊科。体格检查发现该男性脱水，伴有心动过速和库斯莫尔呼吸。双侧锁骨上区域有皮下气肿。胸部听诊发现哈曼征阳性。实验室检查显示代谢性酸中毒，静脉血pH值为7.08。血浆葡萄糖为1438mg/dl；尿中出现酮体。胸部X线显示皮下气肿和纵隔气肿，在开始治疗糖尿病酮症酸中毒后72小时内自发消退。纵隔气肿是糖尿病酮症酸中毒的一种罕见并发症。认识到严重糖尿病酮症酸中毒可能导致纵隔气肿有助于进行及时处理。
