Shimizu Kentaro, Ogura Hiroshi, Wasa Masafumi, Hirose Tomoya, Shimazu Takeshi, Nagasaka Hironori, Hirano Ken-ichi
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Nutrition. 2014 Sep;30(9):1090-2. doi: 10.1016/j.nut.2014.01.007. Epub 2014 Feb 15.
Although starvation is associated with high in-hospital mortality, its related cardiac complications are not sufficiently understood. The aim of this study was to determine the clinical course and pathogenesis of cardiac complications in malnourished patients.
We reviewed three cases of hypoglycemia and hypotriglyceridemia with cardiac complications in starvation.
This report concerns three patients, respectively suffering from anorexia nervosa, esophageal carcinoma, and Parkinson's disease. Their ages ranged from 18 to 70 y, body mass index was 11.5 ± 1.5 kg/m2 (mean ± SD), and the main symptom was coma. The average blood glucose level was 15.7 ± 7.8 mg/dL without any history of insulin use or diabetes mellitus. In all cases, hypoglycemia was refractory and repetitive so that continuous glucose administration was required to maintain euglycemia. Serum triglyceride and non-esterified fatty acid levels were also very low (7 ± 4 mg/dL and 10 ± 9.1 μEq/L, respectively). Levels of serum potassium, phosphate, and magnesium were almost normal at admission. The main cardiac complications included Takotsubo cardiomyopathy and cardiac arrest. All patients survived as a result of intensive treatment.
Repetitive severe hypoglycemia without known background causes should be viewed as an important sign. Once this occurs, the administration of a much higher caloric input than usual accompanied by intensive monitoring will be required to maintain appropriate glucose levels. The early identification of such patients seems to be essential to reduce the high risk for cardiac complications during starvation and refeeding.
尽管饥饿与高院内死亡率相关，但其相关的心脏并发症尚未得到充分了解。本研究的目的是确定营养不良患者心脏并发症的临床病程及发病机制。
我们回顾了3例饥饿状态下发生低血糖和低甘油三酯血症并伴有心脏并发症的病例。
本报告涉及3例患者，分别患有神经性厌食症、食管癌和帕金森病。他们的年龄在18至70岁之间，体重指数为11.5±1.5kg/m²（均值±标准差），主要症状为昏迷。平均血糖水平为15.7±7.8mg/dL，既往无胰岛素使用史或糖尿病史。在所有病例中，低血糖均难治且反复出现，因此需要持续输注葡萄糖以维持血糖正常。血清甘油三酯和非酯化脂肪酸水平也非常低（分别为7±4mg/dL和10±9.1μEq/L）。入院时血清钾、磷和镁水平几乎正常。主要心脏并发症包括Takotsubo心肌病和心脏骤停。经过强化治疗，所有患者均存活。
无已知背景原因的反复严重低血糖应被视为一个重要体征。一旦发生这种情况，需要给予比平时更高的热量输入并进行强化监测，以维持适当的血糖水平。早期识别此类患者对于降低饥饿和再喂养期间心脏并发症的高风险似乎至关重要。
