严重代谢性碱中毒——诊断难题
Severe metabolic alkalosis-a diagnostic dilemma.
作者信息
Foray Nathalie, Stone Taylor, Johnson Alexander, Ali Mirza, Kulkarni Shreedhar, Gao John, Sreedhar Rajagopal
机构信息
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL, 62794, USA.
Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA.
出版信息
Respir Med Case Rep. 2018 Aug 24;25:177-180. doi: 10.1016/j.rmcr.2018.08.019. eCollection 2018.
BACKGROUND
Cushing's syndrome due to ectopic ACTH secretion has been associated with many cancers; most commonly small cell carcinoma of the lung and bronchial carcinoid tumors. Usually, patients who confer this diagnosis have poor prognosis.
CASE PRESENTATION
A 66-year-old female presented with worsening shortness of breath and weakness over three days. Initial laboratory derangements included severe hypokalemia and metabolic alkalosis. Treatment included high amounts of potassium chloride and acetazolamide. Imaging studies revealed anterior medial right upper lobe lung mass as well as suspicion for many liver metastases. Liver biopsy was sought and was positive for small cell carcinoma.
CONCLUSION
We describe a case of severe metabolic alkalosis and hypokalemia in a patient with Cushing's syndrome due to ectopic ACTH secretion from small cell lung cancer. To our knowledge, this is the first case identified which exhibited such significant metabolic derangements in the form of serum and arterial blood bicarbonate. As prognosis is quite poor, we recommend swift diagnosis and management.
背景
由异位促肾上腺皮质激素（ACTH）分泌引起的库欣综合征与多种癌症相关；最常见的是肺小细胞癌和支气管类癌肿瘤。通常，被诊断为此病的患者预后较差。
病例介绍
一名66岁女性在三天内出现呼吸急促和虚弱加重的症状。最初的实验室检查异常包括严重低钾血症和代谢性碱中毒。治疗包括大量氯化钾和乙酰唑胺。影像学检查显示右肺上叶前内侧有肿块，同时怀疑有多处肝转移。进行了肝活检，结果显示为小细胞癌阳性。
结论
我们描述了一例因小细胞肺癌异位分泌ACTH导致库欣综合征的患者出现严重代谢性碱中毒和低钾血症的病例。据我们所知，这是首例以血清和动脉血碳酸氢盐形式表现出如此显著代谢紊乱的病例。由于预后相当差，我们建议迅速进行诊断和管理。
Zotero 插件