心肺骤停后发生中枢性尿崩症和高血糖高渗状态的罕见病例。
An unusual case of central diabetes insipidus & hyperglycemic hyperosmolar state following cardiorespiratory arrest.
作者信息
Masood Muhammad, Kumar Suneel, Asghar Ali, Jabbar Abdul
出版信息
BMC Res Notes. 2013 Aug 16;6:325. doi: 10.1186/1756-0500-6-325.
BACKGROUND
We are describing an unusual case of severe hyperglycemia and hypernatremia, resistant to treatment.
CASE PRESENTATION
A thirty year old female with adenocarcinoma of rectum was admitted with increasing lethargy, headache and drowsiness. She deteriorated rapidly and had cardiac arrest, following which she remained comatose. Her initial serum glucose and sodium were normal, but after receiving dexamethasone and mannitol, the serum glucose progressively increased to 54.7 mmol/L and sodium to 175 mmol/L, despite receiving very high dose of intravenous (IV) insulin infusion. She was evaluated for diabetes insipidus because of continued polyuria even after correction of hyperglycemia. Her serum osmolality was 337 mmol/kg, and urine osmolality was 141 mmol/kg which rose to 382 mmol/kg, after receiving 4 mcg of IV Desmopressin.
CONCLUSION
Our patient developed central diabetes insipidus post cardiac arrest and severe dehydration because of diabetes insipidus. Stress of critical illness, dehydration, dexamethasone and IV dextrose infusion were likely responsible for this degree of severe and resistant to treatment hyperglycemia.
背景
我们正在描述一例严重高血糖和高钠血症的罕见病例，该病例对治疗具有抵抗性。
病例介绍
一名30岁患有直肠腺癌的女性因嗜睡、头痛和困倦加重而入院。她病情迅速恶化并发生心脏骤停，之后一直昏迷。她最初的血糖和血钠正常，但在接受地塞米松和甘露醇治疗后，尽管接受了非常高剂量的静脉胰岛素输注，血糖仍逐渐升至54.7 mmol/L，血钠升至175 mmol/L。即使在高血糖得到纠正后仍持续多尿，因此对她进行了尿崩症评估。她的血清渗透压为337 mmol/kg，尿渗透压为141 mmol/kg，在接受4微克静脉注射去氨加压素后升至382 mmol/kg。
结论
我们的患者在心脏骤停后发生了中枢性尿崩症，并因尿崩症导致严重脱水。危重病的应激、脱水、地塞米松和静脉输注葡萄糖可能是导致这种严重且对治疗具有抵抗性的高血糖的原因。
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