Colombo S, Casati A, Capocasa T, Cornero G, Gallioli G, Torri G
Department of Anaesthesiology and Intensive Care, IRCCS Hospital San Raffaele, Milan.
Minerva Anestesiol. 1997 Nov;63(11):379-82.
The case of a 32-year-old woman admitted to Hospital for diabetic coma (GCS 8), with arterial blood pH below usually reported vital range, is described. After First Aid admittance an arterial blood gas analysis adjusted for patient's temperature showed PaO2 10.77 kPa, PaCO2 7.8 kPa, pH 6.52, HCO3 5 mmol/L, BE-34.9. A significant increase of lactate and butyrate concentration was also found. The patient was intubated and breathing was assisted for a 60 hour period after ICU admission, while acidemia was treated by THAM and bicarbonate associated to potassium i.v. infusion (infusions were titrated on acid-base and electrolyte concentration direct monitoring). After progressive neurological and biochemical improvement, 7 days after ICU admission the patient was moved to an Internal Medicine department. This case demonstrated that during diabetic ketoacidosis, despite very low pH (below reported vital range), an invasive intensive treatment could give complete cure without neurological sequelae.
本文描述了一名32岁女性因糖尿病昏迷（格拉斯哥昏迷评分8分）入院的病例，其动脉血pH值低于通常报道的生命范围。在急救入院后，根据患者体温进行调整的动脉血气分析显示，氧分压（PaO2）为10.77千帕，二氧化碳分压（PaCO2）为7.8千帕，pH值为6.52，碳酸氢根（HCO3）为5毫摩尔/升，碱剩余（BE）为-34.9。同时还发现乳酸和丁酸浓度显著升高。患者入院重症监护病房（ICU）后插管并接受了60小时的呼吸辅助，期间通过三羟甲基氨基甲烷（THAM）和与静脉输注钾相关的碳酸氢盐治疗酸血症（输注根据酸碱和电解质浓度直接监测进行滴定）。在神经和生化状况逐步改善后，入院ICU 7天后患者转至内科。该病例表明，在糖尿病酮症酸中毒期间，尽管pH值极低（低于报道的生命范围），侵入性强化治疗仍可实现完全治愈且无神经后遗症。
