University of Missouri-Kansas City School of Medicine, Department of Internal Medicine, Kansas City, Missouri, USA.
University of Missouri-Kansas City School of Medicine, Department of Surgery, Kansas City, Missouri, USA.
JPEN J Parenter Enteral Nutr. 2019 Sep;43(7):937-940. doi: 10.1002/jpen.1594. Epub 2019 Apr 17.
Diabetic ketoacidosis is defined as hyperglycemia >250 mg/dL with metabolic acidosis of arterial pH <7.3, serum bicarbonate <18 mEq/L with positive urine and serum ketones and an anion gap >10. Euglycemic ketoacidosis has been reported in patients with type 2 diabetes and in patients with type 1 diabetes. However, as a surgical complication, euglycemic ketoacidosis has not been reported. We report 2 cases from 2 teaching tertiary care centers of patients with type 2 diabetes who developed high-gap ketoacidosis in an intensive care unit while recovering from emergent abdominal surgery. Both patients developed altered mental status, metabolic acidosis with a bicarbonate level as low as 14 mEq/L, and an anion gap > 18, without hyperglycemia. Both patients had β-hydroxybutyrate levels > 5 mmol/L.
糖尿病酮症酸中毒的定义为血糖>250mg/dL，动脉血 pH 值<7.3，血清碳酸氢盐<18mEq/L，尿和血清酮阳性，阴离子间隙>10。2 型糖尿病和 1 型糖尿病患者均有报道出现血糖正常的酮症酸中毒。然而，作为一种手术并发症，尚未有血糖正常的酮症酸中毒的报道。我们报告了来自 2 个教学型三级护理中心的 2 例病例，2 例 2 型糖尿病患者在腹部急症手术后的重症监护病房恢复过程中发生高间隙酮症酸中毒。这 2 例患者均出现精神状态改变、代谢性酸中毒，碳酸氢盐水平低至 14mEq/L，阴离子间隙>18，没有高血糖。这 2 例患者的β-羟丁酸水平均>5mmol/L。
