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成人乳糜泻危象:提高对一种危及生命状况的认识

A Celiac Crisis in an Adult: Raising Awareness of a Life-threatening Condition.

作者信息

Ferreira Rogério, Pina Rui, Cunha Nelson, Carvalho Armando

机构信息

Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal.

出版信息

Eur J Case Rep Intern Med. 2016 Feb 4;3(2):000384. doi: 10.12890/2016_000384. eCollection 2016.

Abstract

OBJECTIVES

The Authors report the case of a 56-year-old man with celiac disease, who after ingesting a food containing gluten and experiencing a flu-like syndrome, developed severe diarrhea, vomiting, weight loss (15 kg), hypotension, renal dysfunction, hypokalemia and metabolic acidosis.

MATERIALS AND METHODS

Admission to the Intensive Care Unit and exclusion of an infectious cause was determined.

RESULTS

After receiving noradrenaline, methylprednisolone and correction of ionic disturbances, the patient recovered rapidly and had no further complication.

CONCLUSION

The authors intend to increase awareness of celiac crisis, because despite being extremely rare in adults, it is potentially fatal and an quick diagnosis and treatment are crucial.

LEARNING POINTS

Celiac crisis is an acute, life-threatening presentation of celiac disease.Its clinical presentation consists of severe diarrhea, metabolic disturbances (namely hypokalemia, hyponatremia, hypomagnesemia, hypocalcemia and metabolic acidosis), hypoproteinemia and dehydration.Hospitalization and correction of metabolic imbalance with intravenous fluids are required, with corticotherapy being necessary in some cases.

摘要

目的

作者报告了一例56岁患有乳糜泻的男性病例,该患者在摄入含麸质食物并出现类似流感的综合征后,出现了严重腹泻、呕吐、体重减轻(15千克)、低血压、肾功能不全、低钾血症和代谢性酸中毒。

材料与方法

决定收入重症监护病房并排除感染性病因。

结果

在接受去甲肾上腺素、甲泼尼龙治疗并纠正离子紊乱后,患者迅速康复且未出现进一步并发症。

结论

作者希望提高对乳糜泻危象的认识,因为尽管其在成人中极为罕见,但可能致命,快速诊断和治疗至关重要。

学习要点

乳糜泻危象是乳糜泻的一种急性、危及生命的表现形式。其临床表现包括严重腹泻、代谢紊乱(即低钾血症、低钠血症、低镁血症、低钙血症和代谢性酸中毒)、低蛋白血症和脱水。需要住院并通过静脉输液纠正代谢失衡,某些情况下还需要进行皮质激素治疗。

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本文引用的文献

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Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology.
Gut. 2014 Aug;63(8):1210-28. doi: 10.1136/gutjnl-2013-306578. Epub 2014 Jun 10.
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Clin Gastroenterol Hepatol. 2010 Jul;8(7):587-90. doi: 10.1016/j.cgh.2010.04.009. Epub 2010 Apr 24.
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Current approaches to diagnosis and treatment of celiac disease: an evolving spectrum.
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