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男患,张某,67岁。高血压病史20余年,糖尿病病史10年。平素间断服用降压药治疗。入院前半月,因头昏、头痛加重、血压升高入院。查体:神清,血压28/14.7kPa。心脏听诊心率64次,律齐,心界向左下扩大,A_2亢进,无杂音。辅助检查:心电图示左室负荷加重。X光胸片:主动脉影迂曲,增宽。化验室检查:血糖17.92mmol/L尿糖~(+++)。入院诊断:原发性高血压,高血压性心脏病,糖尿病。给复方降压片2片,每日三次,硝苯吡啶10mg,每日三次及降糖灵和控制饮食治疗。住院第八天开始出现恶心,呕吐,表情淡漠急查血糖74.65mmol/L,两小时后查血糖为16.02mmol/L血酮、尿酮阴性,血钠145mmol/L。随后病
Male suffering, Zhang, 67 years old. More than 20 years of history of hypertension, diabetes history of 10 years. Intermittent medication taking antihypertensive drugs. Half a month before admission, due to dizziness, increased headache, blood pressure admission. Examination: God clear, blood pressure 28 / 14.7kPa. Heart auscultation heart rate 64 times, law Qi, heart to expand to the left, A_2 hyperthyroidism, no noise. Auxiliary examination: ECG showed left ventricular load increased. X-ray: Aortic shadow tortuous, widened. Laboratory tests: blood glucose 17.92mmol / L urine sugar ~ (+++). Admission diagnosis: essential hypertension, hypertensive heart disease, diabetes. To compound antihypertensive tablets 2, three times daily, nifedipine 10mg, three times daily and hypoglycemic and control diet. On the eighth day after hospitalization, nausea and vomiting began to appear, and the blood glucose was 74.65mmol / L. After two hours, the blood glucose level was 16.02mmol / L, ketoneuria, and serum sodium 145mmol / L. Then sick