Fischer K F, Lees J A, Newman J H
N Engl J Med. 1986 Nov 13;315(20):1245-50. doi: 10.1056/NEJM198611133152002.
We analyzed 137 episodes of hypoglycemia (serum glucose less than or equal to 49 mg per deciliter) occurring in 94 adult patients hospitalized during a six-month period at a tertiary care hospital. Forty-five percent of the patients had diabetes mellitus, and administered insulin was implicated in 90 percent of episodes in diabetics. Hypoglycemia in diabetic patients occurred under a variety of circumstances, frequently because of decreased caloric intake related to illness or hospital routine. Insulin-induced hypoglycemia also occurred during treatment of hyperkalemia (eight patients) or during hyperglycemia related to total parenteral nutrition (six patients). Forty-six of the 94 patients had chronic renal insufficiency, and 20 of these 46 had underlying diabetes mellitus. Thus, renal insufficiency unrelated to diabetes mellitus was the second most frequent diagnosis associated with hypoglycemia. The majority of other cases of hypoglycemia were related to liver disease, infections, shock, pregnancy, neoplasia, or burns. Hypoglycemia was not the apparent cause of death in any patient, but the overall hospital mortality was 27 percent and was related to the degree of hypoglycemia and the number of risk factors for hypoglycemia. We conclude that hypoglycemia is a common problem in hospitalized patients, is common in renal insufficiency, is usually iatrogenic, and correlates with high mortality in severely ill patients.
我们分析了一家三级护理医院在六个月期间住院的94例成年患者中发生的137次低血糖事件（血清葡萄糖小于或等于49毫克/分升）。45%的患者患有糖尿病，糖尿病患者中90%的低血糖事件与胰岛素使用有关。糖尿病患者的低血糖发生在多种情况下，通常是由于与疾病或医院常规相关的热量摄入减少。胰岛素诱导的低血糖也发生在高钾血症治疗期间（8例患者）或与全胃肠外营养相关的高血糖期间（6例患者）。94例患者中有46例患有慢性肾功能不全，这46例中有20例患有潜在糖尿病。因此，与糖尿病无关的肾功能不全是与低血糖相关的第二常见诊断。大多数其他低血糖病例与肝病、感染、休克、妊娠、肿瘤或烧伤有关。低血糖不是任何患者的明显死亡原因，但总体医院死亡率为27%，与低血糖程度和低血糖危险因素数量有关。我们得出结论，低血糖是住院患者的常见问题，在肾功能不全患者中常见，通常是医源性的，并且与重症患者的高死亡率相关。
