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胰岛素浮肿临床少见,笔者曾遇2例,报告如下:例1,男,32岁。患糖尿病3年,无明显口渴、多饮、多尿,一直服优降糖和降糖灵治疗,血糖10～12.2mmol/L,尿糖O～++。因劳累最近出现多饮、多尿,治疗40天无好转。既往无肝肾病史。查体:T37℃,BPl9/12kPa。神志清皮肤弹性较差。心率120次/分,律整。两肺听诊正常。腹软,肝脾未及。下肢无浮肿。化验:肝功正常,HBsAg(-)。BUN 5.71mmol5/L,Cr88.4umoi/L。血K~3.2mmol/L、Na+134mm01/L、C191.5 mmol/L、CO_2—CP15.6mmol/L,血糖26.2mmol/L。尿蛋白(一),尿糖(+++),尿酮体强阳性,尿镜检(一)。诊为糖尿病酮症。给胰岛素36u/d 皮下注射,第6天出现尿少,下肢凹陷性浮肿Ⅲ°,阴囊显著肿大。尿常常规2次阴性,酮体(±)。血糖15mmol/L。胰岛素改48u/d 皮下注射,加利尿剂治疗。第9天浮肿开始消退,12天浮肿消失住院40天好转出院。
Insulin edema is clinically rare, I have encountered two cases, the report is as follows: Case 1, male, 32 years old. Diabetes 3 years, no obvious thirst, polydipsia, polyuria, has been serving hypoglycemic and hypoglycemic treatment, blood glucose 10 ~ 12.2mmol / L, urine O ~ +. Due to fatigue recently appeared to drink more, more urine, no improvement for 40 days. Past history of liver and kidney disease. Physical examination: T37 ℃, BPl9 / 12kPa. Slim skin elasticity is poor. Heart rate 120 beats / min, rhythm. Auscultation of both lungs normal. Abdomen soft, liver and spleen not yet. Lower extremity without edema. Assay: Normal liver function, HBsAg (-). BUN 5.71 mmol5 / L, Cr88.4umoi / L. Blood K ~ 3.2mmol / L, Na + 134mm01 / L, C191.5mmol / L, CO_2-CP15.6mmol / L, blood glucose 26.2mmol / L. Urinary protein (a), urine sugar (+++), strong urinary ketone body, urinalysis (a). Diagnosis of diabetic ketosis. To insulin 36u / d subcutaneous injection, the first 6 days less urine, lower limb depression edema Ⅲ °, the scrotum was significantly enlarged. Urinary routine 2 negative, ketones (±). Blood sugar 15mmol / L. Insulin to 48u / d subcutaneous injection, plus diuretic treatment. Day 9 edema began to fade, 12 days edema disappear 40 days hospital admission improved.