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患儿男,9个月15天,因精神差1周,神志不清7h 入院。出生史、家族史、既往史、个人史无异常。体检:T36.2℃,P 142 次/min,R 32次/min,BP 83/52mm Hg(1 mm Hg=0.133 kPa),身长68cm,体重8kg。急性面容,深大呼吸,面色苍白,意识不清,颈无抵抗,双瞳孔等大等圆,对光反射存在,咽无红肿,双肺呼吸音粗,闻及痰鸣音,心律齐,心音强,无杂音,腹软,肝脾无肿大,未及包块,布、克氏征阴性,双巴氏征阴性,膝腱反射存在,四肢肌张力偏低。当地头颅 CT 示两侧额叶脑沟增宽。急诊测血糖24mmol/L,予胰岛素0.1 U/(kg·h)静脉泵维持数分钟后降至2.1 mmol/L 而停用,之后血糖波动于2.9～5.3 mmol/L;尿常规:酮体(+++),酸碱度6.0,尿比重1.025;血常规、粪常规、C 反应蛋白正常;血生化:总蛋白60.8 g/L,白蛋白18.0g/L,ALT 37 U/L,AST 34 U/L,尿素氮11.18 mmol/L,肌酐88.7μmol/L;血氨76μmol/L;血酮5.6 mmol/L;血培养示微
Children male, 9 months 15 days, due to poor mental 1 week, 7h unconscious admission. Birth, family history, past history, personal history without exception. Physical examination: T36.2 ℃, P 142 times / min, R 32 times / min, BP 83/52 mm Hg (1 mm Hg = 0.133 kPa), body length 68cm, weight 8kg. Acute face, deep breathing, pale, unconsciousness, neck non-resistance, double pupil and other round, the presence of light reflex, pharyngeal no redness, lung breath sounds coarse, smell and phlegm, rhythm Qi, heart sounds Strong, no noise, abdominal soft, no swelling of the liver and spleen, mass and mass, cloth, Kirschner wire negative, double negative Bar’s sign, knee tendon reflexes, limb muscle tension is low. Local head CT showed bilateral frontal sulci widening. Emergency blood glucose 24mmol / L, to insulin 0.1 U / (kg · h) intravenous pump to maintain a few minutes to 2.1 mmol / L and disabled, then fluctuations in blood glucose 2.9 ~ 5.3 mmol / L; urine routine: ketone body The total protein 60.8 g / L, albumin 18.0 g / L, ALT 37 U / L, AST 34 U / L, L, blood urea nitrogen 11.18 mmol / L, creatinine 88.7μmol / L; blood ammonia 76μmol / L; blood ketone 5.6 mmol / L;