新生儿低血糖及低血糖脑损伤

低血糖是新生儿期常见的代谢紊乱之一,也是新生儿医学中的一个颇有争议的问题.争议的焦点主要围绕低血糖的定义、对脑的损害、干预的阈值以及远期的预后等相关问题,这些问题的提出已经引起产科和新生儿护理的改进,然而,低血糖所致的脑损伤仍然常有发生.尽管新生脑对低血糖有比成人更好的抵抗力,当低血糖持续时间过长、低血糖同时伴有缺氧缺血或惊厥等其他事件时,发生脑损伤的可能性明显增加.严重的持续的低血糖可损伤大脑皮质的神经元,也可损伤皮质下白质的胶质细胞,特别是后部的顶-枕部区域,常见的神经学后遗症包括脑瘫、智力低下、视觉障碍、惊厥和小头.因此,尽管新生儿低血糖的诊断标准为血糖值低于2.2 mmol/L(40 mg/dL),干预的阈值应该为2.6mmoL/L(45～50 mg/dL).     

Sertraline-induced hypoglycemia.

OBJECTIVE: To report a case of hypoglycemia that occurred in a patient treated with the selective serotonin-reuptake inhibitor, sertraline. CASE SUMMARY: An 82-year-old white woman with mild cardiovascular disease and no history of glucose intolerance was seen in the emergency department for a presyncopal episode associated with a blood glucose of 32 mg/dL as measured by the ambulance attendant. She had similar symptoms the day before. Despite repeated administration of oral and intravenous glucose, the patient had recurrent episodes of hypoglycemia and was hospitalized for four days. She had started taking sertraline 50 mg once daily for mild depression 25 days prior to presentation. Other medications included furosemide 20 mg/d, ramipril 5 mg/d, clopidogrel 75 mg/d, nitroglycerin patch 0.4 mg/h, and lorazepam 1 mg taken occasionally for agitation. She had never been prescribed any oral hypoglycemic agents. Serum sertraline and desmethylsertraline concentrations measured two, three, and four days after discontinuing sertraline were within the expected range, but the rate of decline was consistent with a moderately prolonged half-life. DISCUSSiON: Sertraline has been shown to blunt postprandial hyperglycemia in rats and to potentiate the hypoglycemic effects of sulfonylurea agents in humans. It has not been reported to cause hypoglycemia independently, but in this case, a nondiabetic patient experienced multiple episodes of hypoglycemia that resolved after discontinuation of sertraline. CONCLUSIONS: This report and another implicating fluoxetine in a case of hypoglycemia suggest that healthcare professionals should consider these medications among the possible causes of hypoglycemia occurring in patients receiving selective serotonin-reuptake inhibitors.     

Possible gatifloxacin-induced hypoglycemia

OBJECTIVE: To report a case of hypoglycemia in a patient receiving gatifloxacin for presumed exacerbation of chronic obstructive pulmonary disease (COPD). CASE SUMMARY: A 73-year-old white man with an extensive past medical history significant for type 2 diabetes mellitus and COPD was prescribed gatifloxacin 400 mg/d for a COPD exacerbation. After 2 days of therapy, the patient presented to the emergency department (ED) reporting worsening symptoms; he had a blood glucose concentration of 22 mg/dL. Because he had not eaten well for several days, the patient discontinued his oral antidiabetic medications prior to presenting to the ED, but continued to take gatifloxacin. The patient had never before experienced a symptomatic hypoglycemic episode during the years of taking his antidiabetic medications. In the ED, he received 1 last dose of gatifloxacin and was treated aggressively with intravenous dextrose. By the end of his hospitalization, antidiabetic medication was restarted to control hyperglycemia. DISCUSSION: Although gatifloxacin has been shown to alter glucose homeostasis, the mechanism of action has not been elucidated. Other recognized risk factors that contribute to the development of hypoglycemia are discussed. Our patient experienced hypoglycemia after receiving gatifloxacin and recovered 24 hours after discontinuation. The Naranjo probability scale suggests a possible drug-related event. CONCLUSIONS: The temporal relationship of gatifloxacin administration and the hypoglycemic episode suggests that gatifloxacin likely precipitated the event. Clinicians should be aware of this adverse effect in patients taking gatifloxacin presenting with hypoglycemia.     

左氧氟沙星与低血糖

Giberl等报道了1例86岁的老年女性在应用左氧氟沙星后出现低血糖.该患者长期在护理院生活,有难治性糖尿病史40余年,每天予34 u中效胰岛素,偶尔加用短效胰岛素治疗.     

Persistent hyperinsulinemic hypoglycemia (PHHI)--surgical management of neonatal hypoglycemia

Sporadic persistent hyperinsulinemic hypoglycaemia in a newborn is a rare disease which requires early surgical treatment if conservative therapy fails. We report on a newborn female in whom PHHI was diagnosed at the second day of life. She presented with severe hypoglycemia and high levels of plasma insulin. Conservative treatment failed and a near-total pancreatectomy was performed on the 24th day of life. The postoperative outcome and the follow-up studies showed the patient to be euglycaemic. If hypoglycaemia is resistant to conservative therapy, surgical treatment is recommended. A loss of pancreatic exocrine function is not necessarily to be expected.     

Management of diabetes-related hypoglycemia

Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are minor and easily self-treated. Understanding the factors contributing to hypoglycemia risk and how to minimize its occurrence is an essential part of diabetes care. Building on the physiologic fundamentals presented in the accompanying review, the incidence, mortality/morbidity, clinical symptoms, severity classification, and psychosocial impact of hypoglycemia are described here. Appropriate selection and titration of therapeutic agents, including insulin analogs with more predictable time-action profiles than human insulin formulations, can reduce hypoglycemia risk. Patient education about hypoglycemia prevention, including symptom recognition and necessity of rapid treatment, behavioral modification, and the importance of frequent blood glucose monitoring should accompany all therapeutic interventions.     

Glycated hemoglobin in hypoglycemia

The effect of hypoglycemia--caused by hyperinsulinism in insulinoma patients and in diabetic patients with frequent episodes of hypoglycemia--on glycated hemoglobin was studied. The amount of sugar bound to total hemoglobin in hypoglycemia samples was found to be significantly lower than in those which were normal or hyperglycemic. The amount of total HbA1 fraction, as determined by the mini-column method, was significantly higher than expected on the basis of the corresponding values for total glycated hemoglobin. Evidence is presented to show that this is due to the formation of a hitherto unrecognized HbA1 constituent(s) denoted here as HbA1x.