格列齐特、格列吡嗪相关低血糖及昏迷

1例69岁女性2型糖尿病患者因突发言语不清和口角歪斜入院。入院前服用格列齐特80 mg,2次/d和阿司匹林0.1 g,1次/d。查血糖:1.7 mmol/L。给予50%葡萄糖100 ml静脉注射。1 h后血糖升至20 mmol/L,症状缓解。停用格列齐特,改为格列吡嗪缓释片5 mg,1次/d。次日,患者空腹血糖1.7 mmol/L、餐后血糖2.7 mmol/L,并有心慌、头晕等症状。静脉滴注10%葡萄糖250 ml后症状好转。入院第3～5天停用降糖药,患者血糖维持在空腹8.2 mmol/L、餐后10.1 mmol/L左右。第6天再用格列吡嗪缓释片5 mg,1次/d,血糖维持在5.5～6.5 mmol/L。2 d后患者出院,继续服用格列吡嗪缓释片。出院12 d,患者再次突发意识丧失,呼之不应,遂再次入院。查血糖示:1.6 mmol/L。入院第3天开始给予二甲双胍治疗,餐后2 h血糖维持在8.7 mmol/L左右。第9天患者出院。

Hypoglycemia and coma associated with gliclazide and glipizide

A 69-year-old woman with type 2 diabetes suddenly developed slurred speech and mouth distortion and then was hospitalized.Before admission,the patient received gliclazide 80 mg twice daily and aspirin 0.1 g once daily.A blood glucose test showed a glucose level of 1.7 mmol/L.An IV injection of 50% glucose 100 ml was administered.One hour later,her blood glucose level increased to 20 mmol/L,and her symptoms relieved.Gliclazide was discontinued and replaced with 1 tablet of sustained-release glipizide 5 mg on...