病历摘要 患者女,38岁。因肢体瘫痪、烦渴、多尿2年,伴呼吸困难2天入院。2年前出现四肢无力,行动困难,逐渐全身瘫痪,伴烦渴、多饮(饮水量比平时多1/3)、多尿(尿量3000ml/d)、胸闷、恶心、腹胀等。在当地医院多次查血钾均低于正常(2～2.5mmol/L),口服钾盐1年多未见效。2天来肢体软瘫,不能抬头转颈,且呼吸困难。无烟酒嗜好,家族无类似病史。查体:T36.5℃,P108次/min,R32次/min,BP16/10kPa。神志不清,口唇、指(趾)甲青紫,瞳孔缩小,对光反射迟钝,角膜反射消失。胸部呼吸运动减弱。心率120次/min,律不齐,心音低钝,未闻及杂音,心界无扩大。腹部平软,肝脾未触及。四肢肌力O级,张力减弱,腱反射消失,无病理反射。辅助检查:白细胞8.3×10~9/L,中性粒细胞0.87,淋巴细胞0.13,红细胞3.8×10~(12)/L,血红蛋白110g/L,血小板212×10~9/L。尿持续碱性,镜检无异常, Patient history Female, 38 years old. Due to limb paralysis, polydipsia, polyuria 2 years, with respiratory difficulties 2 days admission. 2 years ago appeared limb weakness, difficulty in operation, and gradually paralyzed, with thirst, drink more (more than 1/3 more than usual), polyuria (urine output 3000ml / d), chest tightness, nausea, bloating and so on. Potassium in the local hospital repeatedly check potassium were lower than normal (2 ~ 2.5mmol / L), oral potassium more than 1 year did not work. 2 days limb paralysis, can not look up neck, and breathing difficulties. Smoke-free wine hobby, no similar family history. Physical examination: T36.5 ℃, P108 times / min, R32 times / min, BP16 / 10kPa. Confusion, lips, finger (toe) bruising, pupil shrinking, light reflex slow, corneal reflex disappears. Breathing motion decreased. Heart rate 120 beats / min, irregular arrhythmia, low heart sound blunt, no smell and noise, no expansion of the heart. Abdomen soft, liver and spleen not touched. O-limb muscle strength, tension weakened, tendon reflex disappeared, no pathological reflex. Auxiliary examination: white blood cells 8.3 × 10 ~ 9 / L, neutrophils 0.87, lymphocytes 0.13, erythrocyte 3.8 × 10 12 / L, hemoglobin 110g / L, platelets 212 × 10 ~ 9 / L. Urine continued alkaline, no abnormal microscopic examination,