Ho Jamie S Y, Mui Bryan, Sia Ching-Hui, Djohan Andie H, Mok Shao-Feng, Chan Mark Y, Ambhore Anand A
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
School of Medicine Trinity College Dublin, Ireland.
Cardiovasc Endocrinol Metab. 2020 Apr 17;9(4):186-188. doi: 10.1097/XCE.0000000000000205. eCollection 2020 Dec.
A 78-year-old male presented with shortness of breath, metabolic acidosis, severe hyperglycaemia and ketonemia. Inferior ST-elevation was present on 12-lead ECG with raised troponin I, but coronary arteries were normal on emergency cardiac catheterization. Despite no previous history of diabetes mellitus and normal HbA1c levels 7 months prior, diabetic ketoacidosis (DKA) was diagnosed, complicated by subsequent shock. The underlying cause was acute pancreatic disease, supported by elevated pancreatic enzyme levels and a history of chronic heavy alcohol use. There are no previous reports, to our knowledge, of patients with acute pancreatitis presenting to the ED with secondary DKA mimicking STEMI.
一名78岁男性出现呼吸急促、代谢性酸中毒、严重高血糖和酮血症。12导联心电图显示下壁ST段抬高，肌钙蛋白I升高，但急诊心脏导管检查显示冠状动脉正常。尽管既往无糖尿病病史，且7个月前糖化血红蛋白水平正常，但仍诊断为糖尿病酮症酸中毒（DKA），并并发休克。潜在病因是急性胰腺疾病，这得到了胰酶水平升高及长期大量饮酒史的支持。据我们所知，此前尚无急性胰腺炎患者因继发性DKA酷似ST段抬高型心肌梗死（STEMI）而到急诊科就诊的报道。
