Department of Emergency Medicine, University of Vermont Medical Center, Burlington, Vermont.
Department of Pharmacy, University of Vermont Medical Center, Burlington, Vermont.
J Emerg Med. 2023 Aug;65(2):e81-e92. doi: 10.1016/j.jemermed.2023.04.018. Epub 2023 Apr 26.
Hyperglycemia is a common finding in patients presenting to the emergency department (ED). Recommendations addressing uncomplicated hyperglycemia in the ED are limited, and the management of those without a prior diagnosis of diabetes presents a challenge.
This narrative review will discuss the ED evaluation and management of hyperglycemic adult patients without a history of diabetes who do not have evidence of a hyperglycemic crisis, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state.
Many adults who present to the ED have risk factors for diabetes and meet American Diabetes Association (ADA) criteria for diabetes screening. A new diagnosis of type 2 diabetes can be established in the ED by the ADA criteria in patients with a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) and symptoms of hyperglycemia. The diagnosis should be considered in patients with an elevation in random blood glucose > 140 mg/dL (7.8 mmol/L). Treatment may begin in the ED and varies depending on the presenting severity of hyperglycemia. Treatment options include metformin, long-acting insulin, or deferring for close outpatient management.
Emergency clinician knowledge of the evaluation and management of new-onset hyperglycemia and diabetes is important to prevent long-term complications.
高血糖在急诊科（ED）就诊的患者中较为常见。针对 ED 中不伴并发症的高血糖的推荐意见有限，且对于无糖尿病既往诊断的患者的管理颇具挑战。
本综述将讨论 ED 中对既往无糖尿病史且无高血糖危象（如糖尿病酮症酸中毒或高渗性高血糖状态）证据的成年高血糖患者的评估和管理。
许多到 ED 就诊的成年人有糖尿病的危险因素，符合美国糖尿病协会（ADA）的糖尿病筛查标准。对于随机血浆葡萄糖≥200mg/dL（11.1mmol/L）且有高血糖症状的患者，ADA 标准可在 ED 中诊断为 2 型糖尿病新诊断。对于随机血糖升高>140mg/dL（7.8mmol/L）的患者，应考虑诊断。治疗可在 ED 开始，并根据高血糖的严重程度而有所不同。治疗方案包括二甲双胍、长效胰岛素或推迟至密切的门诊管理。
急诊临床医生对新发高血糖和糖尿病的评估和管理的了解，对于预防长期并发症很重要。
