Altabas Velimir, Altabas Karmela, Berković-Cigrovski Maja, Malosevac Sanja, Vrkljan Milan, Nikolić Heitzler Vjeran
University Department of Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Acta Clin Croat. 2012 Mar;51(1):71-7.
Glucose metabolism disorders in acutely ill patients include oscillations in plasma glucose concentration outside the range of reference values. These disorders include both hyperglycemia and hypoglycemia, regardless of previous diagnosis of diabetes in a particular patient. Hyperglycemia is frequent in acute patients due to the increased release of stress hormones such as catecholamines and cortisol, but also as an effect of a cascade of proinflammatory cytokines in emergencies such as acute coronary syndrome, pulmonary edema, pulmonary embolism, injuries, severe infections and sepsis. Hyperglycemia occurs often even in patients in whom diabetes was not previously diagnosed, and in diabetic patients requirement for hypoglycemic medication may be temporarily increased. Hyperglycemia in cardiac emergencies is associated with more frequent adverse major cardiovascular events and worse prognosis. Hypoglycemia occurs seldom in these patients, its origin is almost always iatrogenic, and it worsens the patient's prognosis even more than moderate hyperglycemia. Good regulation of glycemia is necessary in the management of these patients; therefore plasma glucose determination and close monitoring are obligatory, and therapy with short acting insulin should be introduced if plasma glucose concentration exceeds 10 mmol/L, regardless of the risk of hypoglycemia. It is also useful to determine the acid-base status and blood or urine ketones.
急性病患者的葡萄糖代谢紊乱包括血浆葡萄糖浓度在参考值范围之外波动。这些紊乱包括高血糖和低血糖，无论特定患者先前是否被诊断为糖尿病。由于应激激素如儿茶酚胺和皮质醇的释放增加，高血糖在急性病患者中很常见，但在急性冠状动脉综合征、肺水肿、肺栓塞、损伤、严重感染和脓毒症等紧急情况下，一连串促炎细胞因子的作用也会导致高血糖。即使在先前未被诊断为糖尿病的患者中，高血糖也经常发生，而糖尿病患者对降糖药物的需求可能会暂时增加。心脏急症中的高血糖与更频繁的严重不良心血管事件和更差的预后相关。低血糖在这些患者中很少发生，其起源几乎总是医源性的，并且它比中度高血糖更会恶化患者的预后。对这些患者进行管理时，良好的血糖调节是必要的；因此，血浆葡萄糖测定和密切监测是必须的，如果血浆葡萄糖浓度超过10 mmol/L，无论有无低血糖风险，都应采用短效胰岛素治疗。确定酸碱状态以及血液或尿液中的酮体也很有用。
