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国际区域性疾病

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虚弱的旅游者
原作者: Andrea Tenner, 步涨 翻译 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-08-05

Title: The Weak Traveler
题目:虚弱的旅游者
Author 作者: Andrea Tenner
翻译:步涨 校对:陈都,肖锋

Case Presentation:
病例陈述
A 64 yo male with a history of IDDM presents with generalized fatigue. He felt so weak last night that he missed his pm dose of Lantus and vomited this morning. He arrived with a critically elevated BG of 590. He flew to the US from Sierra Leone 3 days ago.
一位64岁男性,既往有胰岛素依赖型糖尿病(insulin-dependent diabetes mellitus),主诉全身乏力。昨夜感到非常虚弱,因此晚上没有注射其平时应常规使用的来得时(lantus),今晨出现呕吐。来院时,血糖高达590mg/dl。三天前,他刚从塞拉利昂乘坐飞机回到美国。
Labs include:
实验室检查结果:
Wbc 3.5 Plt 34 Hb 12 Hct 36
血常规:白细胞 3.5*10^9/L;血小板 34*10^9/L;血色素12g/dL;红细胞压积 0.36
Na 125 CL 93 Co2 14 K 4.5 BUN 25 Cr 1.9 Glu 590 AG 18
生化:Na 125 CL 93 Co2 14 K 4.5 BUN 25 Cr 1.9 Glu 590 AG 18
VBG pH 7.23
静脉血气:PH 7.23
Clinical Question:
临床问题:
Other than treating his diabetic ketoacidosis and renal failure, would you send any further tests?
除了治疗该患者的糖尿病酮症酸中毒及肾衰,还需进行哪些更进一步的检查?
Answer:
答案:
Thick smear for Malaria.
进行厚血涂片查找疟原虫。
Bottom Line:
要点:
•DKA is often a symptom of an underlying metabolic or infectious insult
•糖尿病酮症酸中毒通常会在代谢或感染应激情况下出现。
•Have a high suspicion for malaria in those travelers coming from endemic regions and don't forget malaria symptoms are often insidious presenting with myalgia and fatigue, as well as the traditional undulating fevers and chills
•对于那些近期从流行疫区来的旅行者,需要高度怀疑疟疾的可能性,不能忘记疟疾症状通常可能很隐匿,除了典型的持续性发烧及寒战外,还表现为肌肉酸痛及乏力。
•In addition to anemia, thrombocytopenia has been seen in  P. vivax and P. falciparum. (In the at-risk traveler, this finding should raise your suspicion for malaria.)
除了贫血之外,血小板减少也可见于间日疟及恶性疟。
(在高危旅行者中,如发现贫血及血小板减少,需高度怀疑疟疾可能)

References 参考文献:
Ansari, Khoharo, Akhund, and Qureshi. Thrombocytopenia in plasmodium falciparum malaria.J Ayub Med Coll Abbottabad. 2009 Apr-Jun;21(2):145-7.
 Kumar and Shashirekha. Thrombocytopenia--an indicator of acute vivax malaria. Indian J Pathol Microbiol. 2006 Oct;49(4):505-8.
Lacerda, Mourao, Coelho, and Santos. Thrombocytopenia in malaria: who cares? Mem Inst Oswaldo Cruz. 2011 Aug;106 Suppl 1:52-63.
 

文章来源:《中华急诊医学杂志》编辑部