Malone M L, Klos S E, Gennis V M, Goodwin J S
Section of Geriatrics, University of Wisconsin Medical School, Milwaukee.
Arch Intern Med. 1992 Dec;152(12):2472-7.
Previous studies of the management of diabetic ketoacidosis have noted a wide range of incidence of hypoglycemia but have not studied the risk factors associated with it.
To describe the incidence of hypoglycemia in patients hospitalized with diabetic ketoacidosis, we retrospectively reviewed the charts of all adult patients with the diagnosis of diabetic ketoacidosis at three private, community hospitals in Milwaukee, Wis, between January 1, 1987, and May 31, 1990. Two hundred twenty admissions in 150 patients met our inclusion criteria.
In 30% (66/220) of cases of diabetic ketoacidosis, a serum glucose level or Accu-Chek (Boehringer-Mannheim, Indianapolis, Ind) finding was 2.7 mmol/L or less during the first 14 days of hospitalization. No factors could be identified that were associated with a significantly increased risk of early hypoglycemia (within the first 48 hours of admission). The risk of a "late" occurrence of hypoglycemia (after 48 hours of hospitalization) was increased by fever (relative risk, 2.05; 95% confidence interval [CI], 1.16 to 3.63), "nothing orally" status (relative risk, 3.01; 95% CI, 1.88 to 4.83), hepatic disease (relative risk, 2.56; 95% CI, 1.39 to 4.70), and renal disease (relative risk, 2.07; 95% CI, 1.26 to 3.39). A logistic regression analysis showed "nothing orally" status to be associated with an increased risk of any hypoglycemia occurring during the hospitalization (relative risk, 2.39; 95% CI, 1.63 to 3.51). Physicians and nurses documented the first episode of hypoglycemia in their notes 45.5% and 80.3% of the time, respectively.
Hypoglycemia is still a common complication of diabetic ketoacidosis, is associated with hepatic and renal disease as well as fever and "nothing orally" status, and is not documented well in physician notes.
既往关于糖尿病酮症酸中毒治疗的研究指出低血糖发生率范围较广，但未对与之相关的危险因素进行研究。
为描述糖尿病酮症酸中毒住院患者的低血糖发生率，我们回顾性查阅了1987年1月1日至1990年5月31日期间威斯康星州密尔沃基市三家私立社区医院中所有诊断为糖尿病酮症酸中毒的成年患者的病历。150例患者中的220次入院符合我们的纳入标准。
在30%（66/220）的糖尿病酮症酸中毒病例中，住院的前14天内血清葡萄糖水平或血糖仪（德国宝灵曼公司，印第安纳波利斯，印第安纳州）检测结果为2.7 mmol/L或更低。未发现与早期低血糖（入院后48小时内）风险显著增加相关的因素。“晚期”低血糖（住院48小时后）的风险因发热（相对风险，2.05；95%置信区间[CI]，1.16至3.63）、“禁食”状态（相对风险，3.01；95%CI，1.88至4.83）、肝脏疾病（相对风险，2.56；95%CI，1.39至4.70）和肾脏疾病（相对风险，2.07；95%CI，1.26至3.39）而增加。逻辑回归分析显示“禁食”状态与住院期间发生任何低血糖的风险增加相关（相对风险，2.39；95%CI，1.63至3.51）。医生和护士分别在其记录中记录了45.5%和80.3%的首次低血糖发作情况。
低血糖仍然是糖尿病酮症酸中毒的常见并发症，与肝脏和肾脏疾病以及发热和“禁食”状态相关，且在医生记录中记录不佳。
