Bär Sarah, Daudel Fritz, Zueger Thomas
Division of Internal Medicine, Hospital Tiefenau, Inselgruppe AG, University of Bern, Bern, Switzerland.
Division of Intensive Care, Hospital Tiefenau, Inselgruppe AG, University of Bern, Bern, Switzerland.
BMJ Case Rep. 2017 Jun 18;2017:bcr-2017-220328. doi: 10.1136/bcr-2017-220328.
Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis-a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy. Our patient's condition was further aggravated by a circulatory shock, haemodynamic relevant bleeding from a duodenal ulcer and psychotic symptoms. In the intensive care unit, intravenous insulin infusion, fluid resuscitation, catecholamine support, electrolyte supplementation, endoscopic haemoclipping and antibiotic and antipsychotic treatment were administered, leading to a continuous improvement of the patient's health state.
糖皮质激素（CS）在多种疾病的治疗中起着关键作用。尽管如此，它们可能会伴有多种不良反应。我们报告一例51岁女性，因多发性硬化症复发接受大剂量CS治疗。治疗5天后，患者出现严重糖尿病酮症酸中毒、高甘油三酯血症和急性胰腺炎——这是一种潜在的危及生命的三联征，此前已有描述，但在我们的病例中，这是首次作为CS治疗的并发症出现。我们患者的病情因循环性休克、十二指肠溃疡引起的血流动力学相关出血和精神症状而进一步加重。在重症监护病房，给予静脉胰岛素输注、液体复苏、儿茶酚胺支持、电解质补充、内镜下止血夹闭以及抗生素和抗精神病药物治疗，使患者的健康状况持续改善。
