A 35-year-old male patient with type 2 diabetes mellitus was treated with metformin and dapagliflozin orally for a long time. Due to poor glycemic control and overweight, the treatment was adjusted to subcutaneous injection of semaglutide 0.25 mg once a week plus 1 metformin and empagliflozin tablet orally twice daily. The patient experienced abdominal bloating and significant satiety after the first dose, which did not attract attention, and metformin and empagliflozin tablets were not discontinued. Three days later, he developed persistent epigastric pain, and laboratory tests indicated blood ketone body (β-hydroxybutyrate) 4.70 mmol/L. Despite treatments with lansoprazole, anisodamine, metoclopramide, and dezocine, the symptoms was not alleviated. Gastrointestinal decompression was performed, which led to a slight improvement in abdominal pain. An immediate abdominal CT scan revealed gastric retention. The patient′s gastric retention was considered to be associated with the administration of semaglutide. The following day′s laboratory tests indicated carbon dioxide combining power 2.36 mmol/L, suggesting the occurrence of diabetic ketoacidosis, which was hypothesized to be related to empagliflozin. The original hypoglycemic regimen was discontinued, insulin pump therapy was given with blood glucose level monitoring, and fasting, gastrointestinal decompression, fluid resuscitation, and acid suppression was applied. The patient′s symptoms were significantly improved, and the ketone body levels gradually decreased. After 3 days of treatments, the patient began to eat, and after 6 days, he returned to a normal diet without further abdominal pain or bloating. The ketone body levels and carbon dioxide combining power returned to normal, and the hypoglycemic regimen was adjusted to lispro insulin plus acarbose.

A 35-year-old male patient with type 2 diabetes mellitus was treated with metformin and dapagliflozin orally for a long time. Due to poor glycemic control and overweight, the treatment was adjusted to subcutaneous injection of semaglutide 0.25 mg once a week plus 1 metformin and empagliflozin tablet orally twice daily. The patient experienced abdominal bloating and significant satiety after the first dose, which did not attract attention, and metformin and empagliflozin tablets were not discontinued. Three days later, he developed persistent epigastric pain, and laboratory tests indicated blood ketone body (β-hydroxybutyrate) 4.70 mmol/L. Despite treatments with lansoprazole, anisodamine, metoclopramide, and dezocine, the symptoms was not alleviated. Gastrointestinal decompression was performed, which led to a slight improvement in abdominal pain. An immediate abdominal CT scan revealed gastric retention. The patient′s gastric retention was considered to be associated with the administration of semaglutide. The following day′s laboratory tests indicated carbon dioxide combining power 2.36 mmol/L, suggesting the occurrence of diabetic ketoacidosis, which was hypothesized to be related to empagliflozin. The original hypoglycemic regimen was discontinued, insulin pump therapy was given with blood glucose level monitoring, and fasting, gastrointestinal decompression, fluid resuscitation, and acid suppression was applied. The patient′s symptoms were significantly improved, and the ketone body levels gradually decreased. After 3 days of treatments, the patient began to eat, and after 6 days, he returned to a normal diet without further abdominal pain or bloating. The ketone body levels and carbon dioxide combining power returned to normal, and the hypoglycemic regimen was adjusted to lispro insulin plus acarbose.

Objective To research the effect of regulating systemic inflammatory response by using ulinastatin in elderly patients after sevoflurane inhalation of postoperation cognitive function. Methods 60 patients under went elective abdominal surgery, were randomly double-blinded divided into 2 groups. Every group had 30 patients.Group A accepted continuously intravenousiy infusion ulinastatin 2000 units · kg-1 · h-1 , while group B got equivalent continuously intravenous infusion 0.9% sodium chloride injection. The time point of opening eye, extubation, response and the mini-mental state examination(MMSE) score on different time points were observed. Meanwhile, the changes of concentration of hs-CRP, IL-6,IL-10 were measured. Results Compared with two groups,group A has shorter time on response(F =4.399,P = 0.040). Two both groups had decrease of MMSE score 1 hour after surgery compared with preoperation(t =7. 732,11. 916, both P ＜ 0.01), and the score were less than the preoperative value of more than 2 points which showed cognitive decline in patients. But group A's rate of decline in MMSE score was lower than group B(F = 7. 582 ,P =0.012). Both groups had the MMSE score decline 6h after surgery (t = 4. 606,8. 615, both P ＜ 0.05). Group A's score was less than the preoperative value for less than 2 points, group B's score was lower than the preoperative value for more than 2 points, but the difference between the two groups was not significant (P ＞0. 05). Both groups had higher concentrations of hs-CRP、IL-6 、IL-10 at postoperative 1 d ,3d ,7d (all P ＜ 0.01), peaked at postoperative 1 d, and hadn't come back to the preoperative level 7d*after surgery. In group A, the concentrations of hs-CRP, IL-6 increased (postoperative 1 d,3d), but the rate was lower than the group B (F = 14. 885, P = 0.000;F = 4. 405, P = 0. 040; F = 18. 204, P = 0.000; F = 8. 074, P = 0. 006); while the increased rate of concentration of IL-10 was higher than the group B(F=5.197,P=0.026;F= 12.236,P =0.000). Conclusion Ulinastatin could promote the elderly after sevoflurane inhalation rapid recovery of cognitive function, which may be related to the regulation of systemic inflammatory response.