Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Yonsei Med J. 2011 Nov;52(6):898-908. doi: 10.3349/ymj.2011.52.6.898.
Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings.
低血糖是日常临床实践和急性护理环境中常见的现象。严重低血糖 (SH) 的原因是多因素的，主要病因是医源性、感染性疾病伴败血症和肿瘤或自身免疫性疾病。随着糖化血红蛋白值的积极降低以实现最佳血糖控制，患者发生低血糖发作的风险增加。医源性低血糖可导致反复发病，有时甚至导致不可逆的神经并发症，甚至死亡，并进一步排除糖尿病患者一生中保持血糖正常的可能性。最近的研究表明，低血糖与许多急性疾病的不良结局有关。此外，低血糖与老年和非糖尿病住院患者的死亡率增加有关。临床医生应高度怀疑低血糖的微妙症状，并提供及时的治疗。临床医生应该知道，低血糖与许多急性危重病中相当多的不良后果有关。为了降低与低血糖相关的发病率和死亡率，应向因 SH 就诊急诊科的糖尿病患者提供及时的健康教育计划和密切监测。ED 处置策略应进一步验证和证明，以在血糖正常和 SH 风险之间取得平衡。我们讨论了与急诊和重症监护环境中低血糖相关的相关问题。
