糖尿病酮症酸中毒临床误诊分析  

Analysis of Clinical Misdiagnosis of Diabetic Ketoacidosis

作　　者：陶雅辉 房胜辉[1] 李文会[1] TAO Yahui;FANG Shenghui;LI Wenhui(Department of General Internal Medicine,the Second Hospital of Tangshan City,Tangshan,Hebei 063000,China)

机构地区：[1]唐山市第二医院综合内科,河北唐山063000

出　　处：《临床误诊误治》2024年第14期10-13,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2016年度医学科学研究重点课题计划项目(20160904)。

摘　　要：目的分析糖尿病酮症酸中毒(DKA)的误诊原因,提高临床医生对该病的警惕性和诊断准确率。方法回顾分析2020年至2023年收治的3例初诊为其他疾病的DKA患者的临床资料。结果1例初始表现为上腹部剧烈疼痛、恶心及呕吐等,经实验室检查考虑为急性胰腺炎;1例主要症状为腹胀、腹痛和便秘,初诊为肠梗阻;1例主要表现为突发性头痛和意识障碍,初诊为急性脑血管意外。3例均经相关治疗后病情未见明显改善,并进一步行血糖、尿酮体及动脉血气分析,血糖显著升高,尿酮体强阳性,动脉血气分析显示代谢性酸中毒,均确诊为DKA。误诊时间1~4 d。3例确诊后均接受胰岛素和补液等治疗,病情明显改善,预后良好。结论DKA临床表现多样,且缺乏特异性,容易与其他急症混淆,需早期行血糖、尿酮体和动脉血气分析等检查,以便及时识别和诊断DKA,避免误诊导致的不良后果。Objective To analyze the causes of misdiagnosis of diabetic ketoacidosis(DKA),so as to improve the vigilance and diagnostic accuracy of clinicians.Methods The clinical data of 3 DKA patients initially diagnosed with other diseases from 2020 to 2023 were retrospectively analyzed.Results One patient initially presented with severe upper abdomi-nal pain,nausea and vomiting,and was considered to have acute pancreatitis by laboratory examination.The main symptoms of 1 patient were abdominal distension,abdominal pain and constipation,with initial diagnosis of intestinal obstruction.One patient presented with sudden headache and disturbance of consciousness and was initially diagnosed with acute cerebrovascu-lar accident.After relevant treatment,the condition of the 3 patients did not improve significantly.Further examinations,in-cluding blood glucose,urinary ketone body and arterial blood gas analysis,showed significant increase in blood glucose,strong positive urinary ketone body,and arterial blood gas analysis showed metabolic acidosis;all were diagnosed with DKA.The duration of misdiagnosis was 1-4 d.After diagnosis,all the 3 patients received insulin and rehydration therapy,and their conditions were significantly improved with a good prognosis.Conclusion The clinical manifestations of DKA are diverse and lack specificity,which is more likely to be confused with other emergencies.Early blood glucose,urinary ketone body and ar-terial blood gas analysis should be performed as early as possible in order to timely identify and diagnose DKA and avoid ad-verse consequences caused by misdiagnosis.

关 键 词：糖尿病 酮症酸中毒 误诊 胰腺炎 肠梗阻 脑血管意外 血糖 尿酮体 动脉血气分析 

分 类 号：R473.5[医药卫生—护理学]