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患者,女性,23岁。因恶心呕吐、四肢强直性抽搐、尿失禁、昏迷5h来我院急诊。查体:T 36.8℃,P 110次,R22次,BP110/80mmHg。神志不清,压眶及角膜反射消失,双侧瞳孔缩小、光反应消失,肺(-),四肢肌张力增高,偶呈强直性抽搐,腱反射(卅),双侧锥体束征(+)。经询问病史证实患者自服甲磺丁脲90片,每片0.5g,总量为45g。诊断为甲磺丁脲中毒并发低血糖昏迷。 化验:尿:糖(-)、酮醋(-);血象:WBC12×10~9/L,N80％,L20％,血糖1.1mmol/L,K~+2.9mmol/L,Na~+132mmol/L,Cl~-97mmol/L,Ca~(2+)2.2mmol/L,肝肾功能正常,EKG示窦速、T波低平。予以2％小苏打溶液洗胃,每日静滴10％GS2000ml,5％GNS1000ml,KCl 4.0,ViLC 4.0、地塞米松20mg,20％甘露醇250ml,静推50％GS 40ml,每日二次,持续高流量吸氧,抗生素应用。入院第二天血糖上升到2.66mmol/L,
Patient, female, 23 years old. Due to nausea and vomiting, tetanic twitching, urinary incontinence, coma 5h to our hospital emergency room. Physical examination: T 36.8 ℃, P 110 times, R22 times, BP110 / 80mmHg. Unconsciousness, orbital and corneal reflex disappeared, bilateral miosis, photoreaction disappeared, lung (-), limb muscle tension increased, even with tonic convulsions, tendon reflexes (卅), bilateral pyramidal tract signs (+ ). The patient’s history was confirmed by self-serving metoxybutrate 90 tablets, each 0.5g, a total of 45g. Diagnosis of metribuzin poisoning complicated by hypoglycemic coma. Blood samples: WBC 12 × 10-9 / L, N80%, L20%, blood glucose 1.1mmol / L, K ~ + 2.9mmol / L, Na ~ + 132mmol / L, Cl ~ -97mmol / L, Ca ~ (2+) 2.2mmol / L, liver and kidney function was normal, EKG showed sinus speed, T wave low flat. To 2% sodium bicarbonate gastric lavage daily intravenous infusion of 10% GS2000ml, 5% GNS1000ml, KCl 4.0, ViLC 4.0, dexamethasone 20mg, 20% mannitol 250ml, static push 50% GS 40ml twice daily, Continuous high-flow oxygen, antibiotic applications. Blood glucose rose to 2.66mmol / L on the second day of admission,