Lionte Cătălina, Sorodoc L, Laba Victorita
Medical Clinic, Emergency Clinic Hospital, Gr. T. Popa University of Medicine, Iaşi, Romania.
Rom J Intern Med. 2004;42(2):447-55.
Toxic induced hypoglycemia is usually caused by the anti-diabetic treatment and excessive alcohol consume. Hypoglycemia in diabetics treated with insulin or anti-diabetic oral agents is far the most studied form of hypoglycemia. Less information is available on toxic-induced hypoglycemia in non-diabetic subjects with acute exogenous poisoning.
We retrospectively studied adult non-diabetic patients admitted in Emergency Clinic Hospital of Iaşi with hypoglycemia caused by an acute poisoning, over a period of 10 years. Then we performed a prospective study in those poisoning associated with hypoglycemic risk, to assess the prevalence of toxic-induced hypoglycemia.
We identified 15,497 patients with acute poisoning in our retrospective study, 4,005 of whom presented poisoning associated with hypoglycemic risk (40% acute ethanol poisoning, 29% wild mushroom poisoning, 23% beta-blocker poisoning, 7% salicylate poisoning and 1% patients with anti-diabetic agents acute poisoning). The prospective study identified 1,034 patients with acute poisoning, 20.11% of whom had ethanol poisoning, 11.79% had beta-blocker poisoning, 5.89% had wild mushroom poisoning, 1.74% had salicylate poisoning and the rest of 60.47% had other acute poisoning, without hypoglycemic risk. Attempted suicide with anti-diabetic agents in non-diabetic subjects produced the most severe and prolonged form of hypoglycemia in acute poisoning. 23 patients in retrospective study and 6 patients in prospective study died, but in only one situation, the death was the direct consequence of hypoglycemia.
In non-diabetic subjects with acute poisoning, prevalence of toxic-induced hypoglycemia depends on the poison itself, the mechanism of poisoning, also depends on the association between toxics and the severity of toxic- induced liver disease. A useful test to assess toxic-induced hypoglycemia is standard 6 hour oral glucose tolerance test (OGTT). Factors predicting a negative outcome in toxic-induced hypoglycemia are association of toxins, cardiac and hepatic complications, and age (>65 years).
药物性低血糖通常由抗糖尿病治疗和过量饮酒引起。使用胰岛素或抗糖尿病口服药物治疗的糖尿病患者发生低血糖是研究最多的低血糖形式。关于非糖尿病患者急性外源性中毒导致的药物性低血糖的信息较少。
我们回顾性研究了10年间在雅西急诊医院因急性中毒导致低血糖的成年非糖尿病患者。然后，我们对那些与低血糖风险相关的中毒患者进行了前瞻性研究，以评估药物性低血糖的患病率。
在我们的回顾性研究中，共识别出15497例急性中毒患者，其中4005例存在与低血糖风险相关的中毒（40%为急性乙醇中毒，29%为野生蘑菇中毒，23%为β受体阻滞剂中毒，7%为水杨酸盐中毒，1%为抗糖尿病药物急性中毒患者）。前瞻性研究识别出1034例急性中毒患者，其中20.11%为乙醇中毒，11.79%为β受体阻滞剂中毒，5.89%为野生蘑菇中毒，1.74%为水杨酸盐中毒，其余60.47%为其他急性中毒，无低血糖风险。非糖尿病患者使用抗糖尿病药物自杀导致急性中毒时，会出现最严重、持续时间最长的低血糖形式。回顾性研究中有23例患者和前瞻性研究中有6例患者死亡，但只有1例死亡是低血糖的直接后果。
在非糖尿病急性中毒患者中，药物性低血糖的患病率取决于毒物本身、中毒机制，还取决于毒物之间的关联以及药物性肝病的严重程度。评估药物性低血糖的一项有用检查是标准6小时口服葡萄糖耐量试验（OGTT）。预测药物性低血糖不良结局的因素包括毒物联合使用、心脏和肝脏并发症以及年龄（>65岁）。
