乳酸酸中毒合并低血糖昏迷、糖尿病酮症酸中毒和高钾血症一例并文献复习

摘要

目的 总结乳酸酸中毒合并低血糖昏迷、糖尿病酮症酸中毒和高钾血症患者的临床特点,提高临床医师对乳酸酸中毒合并低血糖昏迷、糖尿病酮症酸中毒患者的救治能力.方法 对乳酸酸中毒合并低血糖昏迷、糖尿病酮症酸中毒和高钾血症患者1例的临床特点、病情演变结合文献进行分析.结果 该患者由于同时使用苯乙双胍和格列本脲导致低血糖和酸中毒同时发生,通过补液、积极纠酸、降低血钾和控制血糖治疗2d后病情稳定,乳酸降至正常,生命体征平稳.结论 由苯乙双胍导致的乳酸酸中毒致细胞内血钾转移至细胞外,造成高钾血症;治疗时可加大碳酸氢钠的使用量,积极纠酸,以免错过治疗时机.%Objective To ummarized the clinical characteristics of lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,so to improve the physician's treatment ability by summary the clinical feature of lactic acidosis combined with hypoglycemic coma,diabetic ketosis and hyperkalemia.Methods Analyzed the clinical characteristics and disease development of one case with lactic acidosis combined with hypoglycemic coma,diabetic ketoacidosis and hyperkalemia,and reviewed literature.Results The patient had hypoglycemia and acidosis at the same time due to taking phenformin and glibenclamide.After 2 days,the patient was better through correcting acidosis,intravenous fluid therapy,lowering blood potassium and controlling blood glucose.Conclusion Because acidosis caused the potassium transfer from intracellular to extracellular,the latter leads to hyperpotassemia,lactic acidosis caused by phenformin should be treated with intravenous fluid therapy,correcting acidosis.