Clinical analysis of two extreme diabetic comas after liver transplantation

doi:10.3877/cma.j.issn.1674-0793.2015.03.008

Abstract

Abstract:

Objective

To summarize the diagnosis and treatment of hyperosmolar non-ketotic hyperglycemic coma (HNKHC) and diabetic ketoacidosis (DKA) based on post-transplant diabetes mellitus (PTDM) after liver transplantation.

Methods

The data of 805 patients with liver transplantation in our hospital from January 2005 to December 2013 was reviewed retrospectively. Only 2 cases with HNKHC and DKA were found out. Both cases had no history of diabetes, and used tacrolimus and sirolimus for immunosuppression. After admission, the female had been given methylprednisolone impulse therapy for acute rejection, and tacrolimus was transformed into sirolimus for the male patient.

Results

The female patient was diagnosed as HNKHC, and the male patient suffered from DKA. After comprehensive treatment, such as rapid rehydration, small doses of insulin continuously intravenous dripping, correcting electrolyte and acid-base balance disorders, the symptoms and signs disappeared, and the patients is eventually discharged from the hospital. There was no recurrence on HNKHC, DKA and PTDM after 6 months follow-up.

Conclusions

The morbidity of post-liver transplantation HNKHC and DKA is extremely low, but they are extremely dangerous. The prognosis depends on accurate diagnosis and effective comprehensive treatment in a timely manner.

Key words: Liver transplantation, Post-transplant diabetes mellitus, Hyperosmolar non-ketotic hyperglycemic coma, Diabetic ketoacidosis, Complications, Diagnosis and treatment, Prognosis

Jian Zhou, Weiqiang Ju, Xiaopeng Yuan, Chuanbao Chen, Xingyuan Jiao, Xiaofeng Zhu, Dongping Wang, Xiaoshun He. Clinical analysis of two extreme diabetic comas after liver transplantation[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(03): 211-215.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2015.03.008

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References 24

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项目	例1	例2	参考值
血糖（mmol／L）	33	23.6	2.9～6.0
尿糖	阳性（＋＋＋＋）	阳性（＋＋＋＋）	阴性
尿酮体	阴性	阳性（＋＋＋＋）	阴性
钾离子（mmol／L）	4.43	5.01	3.5～5.3
钠离子（mmol／L）	146	127	135～145
氯离子（mmol／L）	115	102	96～110
尿素氮（mmol／L）	14.5	8.1	2.9～8.6
肌酐（μmol／L）	109	98	53～115
渗透压（mOsm／L）	339	283	275～295
pH	7.35	7.12	7.35～7.45
HCO₃^－（mmol／L）	21	6.2	22～27

项目	例1	例2	参考值
血糖（mmol／L）	33	23.6	2.9～6.0
尿糖	阳性（＋＋＋＋）	阳性（＋＋＋＋）	阴性
尿酮体	阴性	阳性（＋＋＋＋）	阴性
钾离子（mmol／L）	4.43	5.01	3.5～5.3
钠离子（mmol／L）	146	127	135～145
氯离子（mmol／L）	115	102	96～110
尿素氮（mmol／L）	14.5	8.1	2.9～8.6
肌酐（μmol／L）	109	98	53～115
渗透压（mOsm／L）	339	283	275～295
pH	7.35	7.12	7.35～7.45
HCO₃^－（mmol／L）	21	6.2	22～27

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