Department of Emergency Medicine, Queen’s University, Kingston, Ont., Canada.
Can Fam Physician. 2012 Jan;58(1):55-7.
A healthy 19-year-old man presents to your emergency department complaining of weakness and lethargy for the past 2 weeks. He sleeps 10 hours a day, yet remains tired. His appetite has been poor and he constantly feels thirsty. He voids frequently with no dysuria or hematuria. For the past 24 hours, he has been experiencing moderately severe and diffuse abdominal pain; he vomited 4 times in the past 2 hours. He has lost 10 kg over the past 2 weeks. He denies other symptoms or using drugs or medications, and he drinks alcohol only socially. His personal and family medical histories are not relevant. An examination reveals blood pressure of 115/60 mm Hg, heart rate of 135 beats per minute, temperature of 36.9°C, respiration rate of 24 breaths per minute, and oxygen saturation of 100% on room air. The patient is alert and appears uncomfortable, retching repeatedly. The mucosae are dry and the abdomen soft but diffusely tender, with normal bowel sounds and no peritoneal signs. There is no costovertebral angle tenderness. Findings from the remainder of the examination are noncontributory. A bedside glucometer displays “High-High-High.” Laboratory investigations reveal a white blood cell count of 14.2 × 109/L, a hemoglobin level of 143 g/L, a platelet count of 365 × 109/L, a sodium level of 133 mmol/L, a potassium level of 2.9 mmol/L, a chloride level of 103 mmol/L, a blood urea nitrogen level of 17 mmol/L, a creatinine level of 144 μmol/L, a glucose level of 29.7 mmol/L, an arterial pH of 7.10, a Pco(2) of 23 mm Hg, a Po(2) of 95 mm Hg, a bicarbonate level of 11 mmol/L, and an oxygen saturation of 95%. Urinalysis results are positive for high levels of ketones and glucose. How would you approach this patient?
一位健康的 19 岁男性因过去 2 周乏力和嗜睡到急诊就诊。他每天睡 10 小时，但仍感到疲倦。他的食欲不佳，总是感到口渴。他经常排尿，无尿痛或血尿。在过去的 24 小时里，他一直经历着中度严重且弥漫性腹痛；在过去的 2 小时内呕吐了 4 次。他在过去的 2 周内体重减轻了 10 公斤。他否认有其他症状或使用药物或药物，并且仅在社交时饮酒。他的个人和家族病史与本次发病无关。体格检查显示血压 115/60mmHg，心率 135 次/分，体温 36.9°C，呼吸频率 24 次/分，室内空气下血氧饱和度 100%。患者意识清醒，表现出不适，反复呕吐。黏膜干燥，腹部柔软但弥漫性压痛，肠鸣音正常，无腹膜刺激征。无肋脊角压痛。其余检查结果无明显异常。床边血糖仪显示“High-High-High”。实验室检查显示白细胞计数 14.2×109/L，血红蛋白水平 143g/L，血小板计数 365×109/L，血钠 133mmol/L，血钾 2.9mmol/L，血氯 103mmol/L，血尿素氮 17mmol/L，肌酐 144μmol/L，血糖 29.7mmol/L，动脉 pH 值 7.10，Pco(2) 23mmHg，Po(2) 95mmHg，碳酸氢盐水平 11mmol/L，血氧饱和度 95%。尿分析结果显示酮体和葡萄糖水平升高。你将如何处理这位患者？
