Yim Carly, Hussein Nassrein, Arnason Terra
Medicine, Division of Endocrinology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada.
Medicine, Division of Endocrinology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
BMJ Case Rep. 2021 Mar 24;14(3):e241109. doi: 10.1136/bcr-2020-241109.
An elderly woman with metastatic breast cancer was admitted with hyperglycaemic hyperosmolar state (HHS) and an elevated haemoglobin A1C. For 1 week, she had experienced confusion, nausea and frequent urination. Preceding this, she had completed seven cycles of capecitabine chemotherapy for her breast cancer. She did not have a history of diabetes prior to chemotherapy. Given the temporal dysglycaemia following the patient's chemotherapy regimen, capecitabine was thought to be a probable offending agent. The patient was acutely treated for HHS, and was discharged on a basal-bolus insulin regimen. Her capecitabine was held pending review with her oncology team. The patient was ultimately titrated down to basal insulin only by her family doctor. Given the common use of capecitabine, it is important to recognise the risk of hyperglycaemic and hyperglycaemic emergencies as potential adverse effects. This highlights the need to monitor blood glucose throughout treatment to prevent hyperglycaemic emergencies.
一名患有转移性乳腺癌的老年女性因高血糖高渗状态（HHS）和糖化血红蛋白A1C升高入院。一周来，她出现了意识模糊、恶心和尿频症状。在此之前，她已完成了七个周期的卡培他滨化疗以治疗乳腺癌。化疗前她没有糖尿病病史。鉴于患者化疗方案后出现的血糖异常，卡培他滨被认为是可能的致病因素。该患者因HHS接受了紧急治疗，并出院时采用基础-餐时胰岛素方案。其卡培他滨暂停使用，等待与肿瘤学团队会诊。该患者最终由家庭医生将胰岛素滴定至仅使用基础胰岛素。鉴于卡培他滨的广泛使用，认识到高血糖和高血糖紧急情况作为潜在不良反应的风险很重要。这凸显了在整个治疗过程中监测血糖以预防高血糖紧急情况的必要性。
