Edo A E, Okaka E, Ezeani I U
Department of Medicine, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria.
Niger J Clin Pract. 2014 Sep-Oct;17(5):658-61. doi: 10.4103/1119-3077.141445.
Hyperglycemic crisis (HC) is an acute complication of diabetes mellitus (DM) that is commonly precipitated by infections and non-compliance with therapy. Viral precipitant of HC is uncommon. To report a rare case of HC unmasked by Lassa fever in a patient previously not known to have diabetes mellitus. A 54 year old lady presented with complaints of generalized body weakness, inability to pass stool, and fever. There was no abdominal pain, vomiting and nausea. There were no features of DM. She is not a known case of diabetes mellitus or hypertension. Patient does not drink alcoholic beverages. There was no history of bleeding from any orifices. She was acutely ill-looking, afebrile, not pale, anicteric, nil pedal oedema. Pulse rate was 110 beats per minute, regular, normal volume. Blood pressure was 110/80 mmHg. Respiratory rate was 26 cycles/minute, breath sound was vesicular. Abdomen was full and moved with respiration. There were no areas of tenderness, no organomegaly, no ascites, and bowel sounds were normoactive. Neurologic examination revealed a conscious patient who was restless. Casual blood glucose was 600mg/dl. Urinalysis: Glycosuria (+++), HbA1c was 12.4%. Lassa PCR done was positive. Patient was managed for hyperglycemic crisis with intravenous normal saline and soluble insulin. She was also commenced on Ribavirin but died of complications of lassa fever. Lassa fever should be included as a precipitant of hyperglycemic crisis in endemic countries.
高血糖危象（HC）是糖尿病（DM）的一种急性并发症，通常由感染和治疗依从性差引发。HC的病毒诱发因素并不常见。报告一例先前未知患有糖尿病的患者因拉沙热引发的罕见高血糖危象病例。一名54岁女性因全身乏力、无法排便和发热前来就诊。无腹痛、呕吐和恶心症状。无DM特征。她既往无糖尿病或高血压病史。患者不饮酒。无任何孔窍出血史。她病容急性，无发热，无苍白，无黄疸，无足部水肿。脉搏率为每分钟110次，规则，强度正常。血压为110/80 mmHg。呼吸频率为每分钟26次，呼吸音呈肺泡音。腹部饱满，随呼吸移动。无压痛区，无脏器肿大，无腹水，肠鸣音正常。神经系统检查显示患者意识清醒但烦躁不安。随机血糖为600mg/dl。尿液分析：尿糖（+++），糖化血红蛋白（HbA1c）为12.4%。拉沙病毒PCR检测呈阳性。患者接受静脉输注生理盐水和可溶性胰岛素治疗高血糖危象。她还开始使用利巴韦林，但死于拉沙热并发症。在流行国家，拉沙热应被列为高血糖危象的诱发因素。
