08:19,19,Jan,2012 | (275/0/0) | Original

pancreatitis metabolic acidosis


Case of newly diagnosed patients with diabetic ketoacidosis, admission routine laboratory tests found that patients with more severe hypertriglyceridemia. Have been reported in the literature, blood triglyceride level 1000 mg / dl or more, the risk of acute pancreatitis patients was significantly higher. In this case, the clinician should do?
Case Summary:
Patients, male, aged 45, admitted that due to traffic accidents abnormal blood sugar. The past year there were more than urine, polydipsia. Examination: breathing 18 times / min, heart rate 117 / min, blood pressure 127/85 mmHg. Development of normal, sane, abdominal soft skin abnormalities. Laboratory tests: serum bicarbonate 16 mEq / L, anion gap 22 mEq / L, glucose level 695 mg / dl, serum amylase and serum lipase normal and positive serum ketone bodies, blood triglyceride 8701 mg / dl, total cholesterol 753 mg / dl, C peptide concentration was 0.8 ng / ml, HbA1C 13.8%.
Admission diagnosis: diabetic ketoacidosis, hypertriglyceridemia.
In the course of treatment, intravenous insulin treatment, serum triglycerides unchanged, and then given heparin 600 U / h continuous infusion therapy, found that triglyceride levels decreased rapidly (see chart), presumed to decline half-life of 7.3 h. Admission on the third day, giving fenofibrate, atorvastatin and
pancreatitis metabolic acidosis

fangguiwei Posted at 2008-10-12 22:47
Misdiagnosed as diabetic ketoacidosis with acute necrotizing pancreatitis a clinical data
【Example 1】 Female, 34 years old. Because of persistent abdominal pain, progressive increase 5 days hospitalization. 5 days ago in the outer 5% glucose infusion 500 ml, plus 6.4 million units of penicillin, abdominal pain was intensified beam strip. Blood test and urine amylase slightly elevated, blood pressure, total abdominal tenderness and rebound tenderness, decreased bowel sounds, diagnosed as acute necrotizing pancreatitis (ANP), emergency hospital surgery. See no abnormal pancreatic surgery. Postoperative irritability, coma, check fasting blood glucose 23.6 mmol / L, urine glucose, ketones, carbon dioxide combining power down. Of insulin therapy in stable condition. Since then the line glucose tolerance and insulin release test simultaneously, diagnosed with type Ⅰ diabetic ketoacidosis.
【Example 2】 male, 27 years old. Abdominal pain, vomiting, irritability 3 days hospitalization. Nearly 1 year to drink alcohol every day half a catty, 3 days ago after drinking heavily the left upper abdominal pain, radiation to the lower back, with nausea, vomiting, irritability, thirst, cough, sputum, palpitation, shortness of breath. Physical examination: body temperature 38.9 ℃, blood pressure 10 / 8 kPa; sense of hazy, extreme irritability; lungs filled with rales dry sex, heart rate 104/min, law Qi, low heart sound b
lunt; muscle tension, the whole abdominal tenderness, rebound positive pain, bowel sounds disappear. Blood test and urine amylase increased, diagnosis ANP, ready to laparotomy. Preoperative blood glucose 21.4 mmol / L, urine ketone bodies (). Diagnosis of diabetic ketoacidosis, immediately to the low-dose insulin therapy, but her condition gradually worsened, there multiple organ failure, died the next day.
Example 3】 【male, 39 years old. 2 days left upper abdominal pain admitted to hospital. 3 days before eating greasy food, the next day there the whole abdominal pain, with nausea, vomiting, thirst, diarrhea. Physical examination: body temperature 38.7 ℃, sweating, listlessness, decreased blood pressure; whole abdominal tenderness and rebound tenderness, smell and sound of air over the water. Blood and urine amylase more than 3 times higher than normal. B-show: pancreatic swelling, peripancreatic effusion. Be diagnosed as ANP, emergency surgical exploration, intraoperative examination no abnormal pancreas. 10% glucose infusion in patients after coma, check blood sugar 29.6 mmol / L, urine ketone (). Diagnosis of diabetic ketoacidosis, insulin treatment for 4 hours to clear, oral glibenclamide therapy, clinical recovery after 3 weeks and discharged.
Discussion 2 .
Severe diabetic ketoacidosis due to lack of insulin caused by increased glucose metabolism, lipolysis tachycardia, increased serum ketone bodies, ketone bodies accumulate in the acid base, and metabolic acidosis occurred. The incentive for more and infection, trauma, major surgery, diet accidentally and so on. The group 3 patients with necrotizing pancreatitis have their common clinical manifestations: â‘  rapid onset; â‘¡ clinical manifestations of nausea, vomiting, abdominal pain, headache, irritability, and hypovolemic shock; â‘¢ blood sugar, blood, urine amylase and elevated white blood cell count, heart rate fast. Result not from the medical history, symptoms and signs, and a comprehensive analysis of test results to determine which lead to misdiagnosis, 2 patients underwent emergency surgery blind, adding to the disease, 1 patient died of multiple organ failure, should be a warning.
gxy1107 Posted at 2008-10-13 12:26
heh edsfdsfdsfdsfdsfdsfsddsfsd
fghi611 Posted at 2008-10-13 20:24
Oh look at the top, you look at the top
ken1591 Posted at 2008-10-13 23:59
Experience ah, it is worth learning
woshishuia0 Posted at 2008-10-14 10:30
Is not good distinction. Thank you, oh
maweilong Posted at 2008-10-15 11:22
Should pay attention
shuweichen Posted at 2008-10-15 19:26
Oh look at the top
I will Jicha such patients experience blood, urine amylase, including the blood sugar of course, is to look closely CT
But often do not Jicha ah urine should be a warning
hu619691 Posted at 2008-10-15 20:06
Good information, thank you provided!
wc46362008 Posted at 2008-10-16 15:10
: Lol: lol: lol: lol: lol:
changtw Posted at 2008-10-17 18:47
CTCT, CT how important
changtw Posted at 2008-10-17 18:52
ANP surgical care what the above case illustrates:
1. Preoperative diagnosis is based on inadequate. B-can not be diagnosed ANP, CT is particularly important at this time.
2, is diagnosed as ANP, nor is it immediately to surgery, medical treatment is now advocated an active preparation for surgery, careful operation, before you have to think about what surgery can achieve results.
changtw Posted at 2008-10-17 18:55
ANP surgical care what the above case illustrates:
1. Preoperative diagnosis is based on inadequate. B-can not be diagnosed ANP, CT is particularly important at this time.
2, is diagnosed as ANP, nor is it immediately to surgery, medical treatment is now advocated an active preparation for surgery, careful operation, before you have to think about what surgery can achieve results.
3, surgery may Debu is still missing.
lijuyang Posted at 2008-10-17 21:33
Agree changtw view.
DKA may be complicated by pancreatitis, urine, blood sugar checks should not be in time to misdiagnosis.
Three cases should be the onset of autoimmune diabetes in adults, should insulin therapy.
Posted at 2008-10-18 11:53 8,950,814
Reply 1 # fangguiwei post diagnosis of the disease there are many clear diagnosis difficult, it is best recommended for difficult diseases encountered in all sections of consultation in order to improve the diagnostic rate.
If we do not think that this fellow patient encounter are likely to experience cases of misdiagnosis, occult: funk: funk: funk:
weihe6121 Posted at 2008-10-20 14:38
CT is the gold standard for diagnosis of it.
"Is diagnosed as ANP, nor is it immediately to surgery, medical treatment is now advocated an active preparation for surgery, careful operation, before you have to think about what surgery can achieve results," said the good
wsxiang Posted at 2008-10-21 11:38
Why not look at blood Jicha
wsxiang Posted at 2008-10-21 11:40
I think that the condition has changed or just admission blood glucose should be Jicha
likun1983 Posted at 2008-12-17 17:18
Re: diabetic ketoacidosis misdiagnosed as acute pancreatitis patients with type 1 diabetes in a lot of discovery is to "diabetic ketoacidosis, coma," admitted the incidence of such patients often have no special medical history before, bringing to the diagnosis a lot of trouble, the disease incidence of acute and risks of other diseases easily confused, which is now part of the hospitals have their own routine examination to include blood glucose among the reasons.
wryd65422020 Posted at 2008-12-19 11:48
Re: misdiagnosed as diabetic ketoacidosis with acute necrotizing pancreatitis, but luckily we have encountered a diagnosis early, no serious consequences, when compared with the symptoms and signs are not to be careful when: funk: funk: funk: / rose
Posted at 2009-2-27 10:10 8105133
Re: misdiagnosed as diabetic ketoacidosis diabetic ketoacidosis with acute necrotizing pancreatitis in a timely manner when dealing with non consequences of misdiagnosis are serious. Should pay attention! Learning, thank you!
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90 cases of acute pancreatitis blood gas and electrolyte analysis Analysis On the Vigour and Electrolyte of 90 Acute pancreatitis cases
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Of acute pancreatitis (AP) arterial blood gas and electrolyte changes. Methods 90 patients with AP were divided into mild group (MAP) and severe group (SAP), collected within 48 hours of onset of arterial blood gas and electrolytes. Results SAP group, PaCO2, PaO2, HCO3-was significantly lower than the MAP group (P <0.05), pH, and anion gap (AG) no significant difference between the two groups. In the acid-base metabolism to respiratory alkalosis and respiratory alkalosis or metabolic acidosis, the most common, followed by metabolic acidosis, respiratory acidosis and metabolic acidosis, metabolic alkalosis. electrolyte imbalance low blood calcium-based, particularly more pronounced in patients with SAP (P <0.05). Conclusion hypoxemia in patients with AP, acid-base balance and electrolyte imbalance may ARDS, MODS has existed before the hypoxemia may be an early MODS signal, arterial blood gas and electrolyte monitoring, and early intervention to prevent the occurrence of MODS, mortality reduction is significant. of: Wong Chi Fai Chen Jingbo HUANG Zhi-huiCHEN Jing-bo Author: Huidong County, Guangdong Province People's Hospital, Guangdong, Huidong, 516 300 Title: Modern Medicine ISTIC English title: HAINAN MEDICAL JOURNAL, the volume (of): 2006 17 (10) Key words: R657.5 1 Keywords: acute pancreatitis electrolyte acid-base balance of blood gas analysis machine marked DOI: R5 R58 machine marked keywords : Pancreatitis blood gas electrolyte analyzer respiratory alkalosis metabolic acidosis metabolic alkalosis electrolyte imbalance hypoxemia electrolyte anion gap changes in early intervention in acute acid-base balance mortality of severe low blood calcium metabolism in the prevention side signal monitoring Fund Project: DOI: References (8) Liu Bin. Hao Zhuang De Surgical treatment of acute pancreatitis [Papers
] - Journal of Surgery 2001 (04) Institute of Chinese Medicine Surgery clinical diagnosis of acute pancreatitis and classification criteria (1996 In the second program) [Papers] - Chinese Journal of Surgery 1997, Xing-yuan. Zhaoshang Sheng. Yang Chunming Strategies of surgical treatment of severe pancreatitis [Papers] - Department of General Surgery 1999 (05) Bernard Li School. Wu Guojun. Fan-Tiger severe acute pancreatitis and systemic inflammatory response syndrome of [Papers] - abdominal surgery in 2001 (06) Zhang Yuhui. Wu Lin Quan lung injury in acute necrotizing pancreatitis pathogenesis research [Papers] - Jiangxi Medical College in 2004 (01) Sun Qi. Han Sheng Xi severe acute pancreatitis early hypoxemia and prognosis [Papers] - Journal of Internal Medicine 2000 (03) Xing-Peng Wang. Guoliang. witch Association Acute blood circulation disorders rather the meaning of 1997 (01) Chen Haozhu Practice of internal medicine in 2002
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