问题 问答题 案例分析题

61岁男性患者,15年前因多饮、多食、多尿,诊断为“糖尿病”。长期接受胰岛素治疗与饮食控制,血糖基本上能控制。12年前发现有高血压,并逐渐出现两下肢水肿,加用硝苯地平与利尿药治疗,血压下降速度很慢。近2年夜尿量增多,血糖也较高,对胰岛素剂量进行了调整,每天给予28U。近1周因装修新房,进餐不规则,今上午注射胰岛素后1小时突然感觉全身乏力、心悸、多汗,并出现昏迷,即来院急诊。体检:体温37.0℃,脉率112次/分,呼吸率22次/分,血压200/100mmHg,昏迷。两肺阴性,无病理性杂音。腹软,无压痛与反跳痛。两下肢水肿(+)。神经系统检查:无自主运动,对声、光刺激无反应,角膜反射存在,巴宾斯基征阴性,膝腱反射减弱。患者身高159cm,体重70kg。辅助检查:血糖1.8mmol/L,尿糖(-),血酮0.9mmol/L,尿酮(-),血pH7.35。尿常规:蛋白(++),红细胞0~2个/高倍视野,白细胞0~1个/高倍视野,管型0。请解答:

该患者昏迷的原因是什么?如何紧急处理?根据患者的身高、体重,计算三大营养物质需要量及三餐饮食热量。

答案

参考答案:

糖尿病低血糖性昏迷。应立即给予静脉推注50%葡萄糖液40~60ml。 

患者身高159cm,标准体重=159-105=54kg,每天每千克体重给予热量30kcal,蛋白质1g,糖占60%,计算如下: 

总热量=30×54=1620(kcal) 

碳水化合物=1620×60%/4=972/4=243(g) 

蛋白质=1×54=54(g) 

脂肪=1620-(972+4×54)=132(g) 

三餐热量分配:早餐1/5;午餐2/5;晚餐2/5。也可以四餐分配1/7;2/7;2/7;2/7。

单项选择题

Passage Two

Whales

Whales are aquatic mammals belonging to order CetaceA.A few species live in fresh water, but most species live in the seA.They have a streamlined shape and a powerful tail to drive them forwarD.With its two large horizontal fins or flukes, the tail produces the driving force by beating ply up and down. Flippers at the front are used for steering and balance. The hind limbs of whales have completely disappeared, apart from a few small bones inside the body. Body hair has also disappeared, giving whales a smoother outline and less resistance to water.Instead of hair, whales are insulated by a thick layer of fat, or blubber, under the skin. The blubber may be as much as 61 cm thick on some parts of the body. Besides protecting the animal against the cold, the blubber is an important food reserve.
Most of the best-known whales large creatures.For example, the blue whale reaches a length of more than 30 m.However, many whales, such as dolphins and porpoises, are small.Some are only 1.5 to 1.8 m long.
Whales live entirely in water.Sometimes, whales are stranded on the shore.Although they are air-breathing animals, they soon die because their great weight keeps them from expanding (opening out) the chest cavity.They can breathe easily when afloat, because the water supports most of their weight.
The bottle-nosed whale has been known to stay under water for about two hours.The sperm whale can dive down to depths of 500 fathoms.Such long and deep dives are unusual.Most dives last between 10 and 30 minutes.Whales have special mechanisms that help them to stay under water.When they breathe, they renew about nine-tenths of the air in their lungs.When human beings breathe in, only about one-fourth of the air is renewed.Whales therefore have a fairly large supply of fresh air to start with.They also have an additional oxygen supply in the muscles, where air is loosely held in combination with a pigment called myohaemoglobin.Another thing that helps whales hold their breath for long periods of time is their low sensitivity to carbon dioxide in the blood.(It is the carbon dioxide building up in human blood that affects the brain and makes the human being take another breath.)
When a whale surfaces to renew its air supply, it needs only to push the top of its snout out of the water.This is because the nostril or blowhole is at the top of the heaD.The expelled air is forced out ply to form the spout or blow.
Living whales are divided into two groups—tooth whales and whalebone whales.Tooth whales, which include most species, generally have many conical teeth and eat mainly squids and fishes.The killer whale feeds on seals.One African river dolphin feeds mostly on plants.Other tooth whales include the narwhal and the sperm whale.
Whalebone whales have no teeth.Their mouths contain huge comblike fringes of baleen or whalebone.This horny substance is usually black.All whalebone whales feed by straining small animals from the water.The mouth is filled with water and the water is then forced out through the fringes by the tongue.The animals caught in the baleen are swept into the stomach by the tongue. All whalebone whales are large animals, which are usually found in cold seas.They include the blue whales, the right whales, and the rorquals.
The future of many of the larger kinds of whales is uncertain. Whalers have killed so many blue, bowhead, humpback, and right whales that those species are threatened with extinction. Overhunting has also greatly reduced the number of fin and sei whales.Also, if the human population does not stop increasing, people may have to compete with whales for food in the seA.Some nations have begun fishing for krill.Krill is the chief food of whales in Antarctic waters.

Which of the following is true of whalebone whales according to the passage

A.They live mainly on plants.

B.They are more dangerous than tooth whales.

C.They get small water animals as their fooD.

D.They are frequently found in warm seas.

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