Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St Louis, MO 63110, USA.
Department of Emergency Medicine, Division of Medical Toxicology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8072, St Louis, MO 63110, USA.
Crit Care Clin. 2021 Jul;37(3):577-589. doi: 10.1016/j.ccc.2021.03.007.
Medications used to treat diabetes mellitus are heterogeneous, with widely differing safety profiles in therapeutic use and in overdose. Insulin overdose may produce severe and prolonged hypoglycemia. Sulfonylurea poisoning should be treated with octreotide, sparing intravenous dextrose where possible. Acute metformin overdose may lead to life-threatening acidosis with elevated lactate concentrations, which may require hemodialysis. Glucagon-like peptide 1 agonists and dipeptidyl peptidase 4 inhibitors are benign in overdose in diabetic patients but may produce profound hypoglycemia in nondiabetic patients. Euglycemic diabetic ketoacidosis may develop in critically ill patients taking sodium-glucose co-transporter 2 inhibitors.
用于治疗糖尿病的药物种类繁多，在治疗用途和过量使用方面具有广泛不同的安全性特征。胰岛素过量可能导致严重且持久的低血糖。磺酰脲类药物中毒应使用奥曲肽治疗，在可能的情况下避免静脉输注葡萄糖。急性二甲双胍过量可能导致危及生命的酸中毒和乳酸浓度升高，可能需要血液透析。在糖尿病患者中，胰高血糖素样肽 1 激动剂和二肽基肽酶 4 抑制剂过量时是良性的，但在非糖尿病患者中可能会导致严重低血糖。服用钠-葡萄糖共转运蛋白 2 抑制剂的危重症患者可能会发生血糖正常的糖尿病酮症酸中毒。
