Meeking D R, Krentz A J
Department of Medicine, Royal South Hants Hospital, Southampton, UK.
Diabet Med. 1996 Jun;13(6):587-8. doi: 10.1002/(SICI)1096-9136(199606)13:6<587::AID-DIA34>3.0.CO;2-H.
A 24-year-old previously healthy man presented with a 3-week history of progressively intensifying symptoms of diabetes mellitus. He had become increasingly unwell during the night preceding his admission to hospital and had developed central pleuritic chest pains with nausea; he had vomited once. On admission, he was clinically dehydrated and acidotic with Kussmaul's respiration. A diagnosis of diabetic ketoacidosis was confirmed by laboratory tests (arterial pH 7.21; bicarbonate 11.6 mmol l-1; blood glucose 40.5 mmol l-1, and heavy ketonuria). Subcutaneous emphysema was palpable in the neck tissues and a chest X-ray revealed mediastinal emphysema. There was no clinical or radiological evidence of acute or chronic pulmonary disease and a barium swallow confirmed the integrity of the oesophagus. He made an uneventful recovery from the ketoacidosis with conventional therapy. The subcutaneous emphysema and pneumomediastinum had completely resolved at review 4 weeks later.
一名24岁既往健康的男性，出现了为期3周的糖尿病症状逐渐加重的病史。在入院前一晚，他的病情日益加重，出现了伴有恶心的中央型胸膜炎性胸痛；他呕吐过一次。入院时，他临床上存在脱水和酸中毒，伴有库斯莫尔呼吸。实验室检查确诊为糖尿病酮症酸中毒（动脉血pH 7.21；碳酸氢盐11.6 mmol/L；血糖40.5 mmol/L，且尿酮体强阳性）。颈部组织可触及皮下气肿，胸部X线显示纵隔气肿。没有急性或慢性肺部疾病的临床或放射学证据，钡餐检查证实食管完整。他通过常规治疗从酮症酸中毒中顺利康复。4周后的复查时，皮下气肿和纵隔气肿已完全消退。
