成人 1 型糖尿病患者中，大麻相关性呕吐综合征所致糖尿病酮症酸中毒与高血糖高渗性酮症的鉴别诊断。
Differentiating Diabetic Ketoacidosis and Hyperglycemic Ketosis Due to Cannabis Hyperemesis Syndrome in Adults With Type 1 Diabetes.
机构信息
Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO.
Department of Epidemiology, University of Colorado, Aurora, CO.
出版信息
Diabetes Care. 2022 Feb 1;45(2):481-483. doi: 10.2337/dc21-1730.
OBJECTIVE
To differentiate diabetic ketoacidosis (DKA) from hyperglycemic ketosis due to cannabis hyperemesis syndrome (HK-CHS) in adults with type 1 diabetes.
RESEARCH DESIGN AND METHODS
Of 295 adults with type 1 diabetes who were seen with DKA-related ICD-10 codes, 68 patients with 172 DKA events meeting the inclusion criteria were analyzed. Cannabis use was defined as a positive urine test result for cannabis. Linear mixed models were used to define HK-CHS (pH ≥7.4 with bicarbonate ≥15 mmol/L [mEq/L]), and sensitivity and specificity were calculated using the receiver operating characteristic (ROC) curve.
RESULTS
Cannabis users had significantly higher pH (7.42 ± 0.01 vs. 7.09 ± 0.02) and bicarbonate (19.2 ± 0.61 vs. 9.1 ± 0.71 mmol/L) (P < 0.0001) compared with nonusers. The area under the ROC curve for a positive cannabis urine test result predicting HK-CHS was 0.9892.
CONCLUSIONS
In patients who present with DKA and higher pH, especially pH ≥7.4, cannabis use should be considered in the differential diagnosis.
目的
在 1 型糖尿病成人中，区分糖尿病酮症酸中毒（DKA）与因大麻呕吐综合征（HK-CHS）引起的高血糖性酮症。
研究设计与方法
在 295 名因 DKA 相关 ICD-10 代码就诊的 1 型糖尿病成人中，分析了符合纳入标准的 68 名患者的 172 次 DKA 事件。大麻使用定义为尿液中大麻呈阳性。采用线性混合模型定义 HK-CHS（pH 值≥7.4，碳酸氢盐≥15mmol/L [mEq/L]），并使用受试者工作特征（ROC）曲线计算敏感性和特异性。
结果
与非使用者相比，大麻使用者的 pH 值（7.42±0.01 比 7.09±0.02）和碳酸氢盐（19.2±0.61 比 9.1±0.71mmol/L）显著更高（P＜0.0001）。阳性大麻尿液检测结果预测 HK-CHS 的 ROC 曲线下面积为 0.9892。
结论
在出现 DKA 且 pH 值较高的患者中，尤其是 pH 值≥7.4，应考虑大麻使用作为鉴别诊断。
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