Toda Gotaro, Fujishiro Midori, Yamada Tomohide, Shojima Nobuhiro, Sakoda Hideyuki, Suzuki Ryo, Yamauchi Toshimasa, Ueki Kohjiro, Kadowaki Takashi
Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan.
J Med Case Rep. 2014 Feb 13;8:51. doi: 10.1186/1752-1947-8-51.
Hypoglycemia is a cause of considerable morbidity. Although hypoglycemia has been documented in the setting of septic shock and has been associated with higher mortality, hypoglycemia in infection without sepsis has not been reported in the literature.
A 72-year-old Japanese woman treated with high-dose glucocorticoids for autoimmune hemolytic anemia, as well as intensive insulin therapy for type 2 diabetes, presented with severe hypoglycemia. A lung abscess was diagnosed by imaging studies and treated with intravenous antibiotics. Hypoglycemia spontaneously recurred during lung abscess exacerbations, despite appropriate de-escalation of antidiabetic therapy. Only mild sporadic episodes of hypoglycemia occurred after the lung abscess was controlled. Infection accompanied with malnutrition and immunosuppression, although in the absence of sepsis, may have contributed to hypoglycemia.
Caution is warranted in the management of hypoglycemia in patients with diabetes with the conditions described here, that is malnutrition and immunosuppression, as infection may be a contributing factor.
低血糖是导致相当多发病率的一个原因。尽管在感染性休克的情况下已记录到低血糖，且其与较高死亡率相关，但文献中尚未报道无脓毒症的感染中的低血糖情况。
一名72岁的日本女性，因自身免疫性溶血性贫血接受高剂量糖皮质激素治疗，同时因2型糖尿病接受强化胰岛素治疗，出现了严重低血糖。通过影像学检查诊断为肺脓肿，并接受静脉抗生素治疗。尽管适当减少了抗糖尿病治疗，但在肺脓肿加重期间低血糖仍自发复发。肺脓肿得到控制后仅出现轻度散发性低血糖发作。伴有营养不良和免疫抑制的感染，尽管无脓毒症，可能促成了低血糖。
对于患有糖尿病且伴有此处所述情况（即营养不良和免疫抑制）的患者，在管理低血糖时应谨慎，因为感染可能是一个促成因素。
