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案例回顾患者是一位 54 岁的中年男子，因「呕吐、乏力半天」于下午 14:30 左右入院。
入院当日上午出现恶心、呕吐一次，伴上腹胀痛，程度不剧烈。
此后出现全身乏力，无晕厥。
遂来院就诊。
既往：糖尿病病史9 年，服用格列美脲 4 mg/d，二甲双胍 3.0 g/d；高血压病史 2 年，服用缬沙坦氢氯噻嗪 1 片/d；未监测血糖、血压。
体格检查：T 36.9℃，P 116，R 30，BP 190/80 mmHg。
神志清，心肺腹无明显异常，神经系统阴性。
辅助检查：血常规：WBC 23.1×109/L，N 0.85，HB 102 g/L。
血生化：GLU 0.54 mmol/L，UREA 22.2 mmol/L，CREA 792μmol/L，LDH 271U/L，电解质正常，糖化血红蛋白 6.1%。
BNP：3269pg/mL；肌钙蛋白：0.05 μg/L。
临床诊断：1. 低血糖症；2. 糖尿病；3. 急性肾功能障碍。
治疗经过：入院后立即给予葡萄糖溶液口服及静滴。
经动态血糖监测，16:00 血糖4.2 mmol/L，18:00 血糖 10.3 mmol/L。
此时患者症状改善，安静休息。
因 BNP 高达 3269pg/mL（报危急值），请心内科会诊，会诊意见暂无需处理；因肾功能异常，请肾内科会诊，建议予托拉噻米 3 支静注，随后予呋塞米微量泵持续注射。
晚上 21:00 患者血压降至125/74 mmHg，22:00 血压 90/55 mmHg，此时患者状态平静。
23:00 左右，患者血压进一步下降至 63/37 mmHg，伴意识丧失，呼之不应。
查体见瞳孔散大，光反应迟钝。
进行紧急复苏抢救等措施，但最终抢救无效患者死亡。
乍一看好似简单的「低血糖症」，却在一天内夺人性命！患者的死亡原因究竟是什么？接诊后这一系列处理真的 OK 吗？来一起看看丁香园站友的精彩分析。
关于案例的 4 点疑问1. 肾功能衰竭患者肾功能衰竭是急性还是慢性？从血红蛋白来看可能是慢性或者慢+急，慢性肾衰竭药物蓄积中毒？磺脲类引起严重低血糖？双胍类乳酸中毒？是否做了动脉血气分析？代谢性疾病，酸碱度、电解质情况都很关键，血气是必须要做的。
低血糖疑难病例讨论记录范文英文回答：Low blood sugar, also known as hypoglycemia, can be a challenging condition to diagnose and treat. It occurs when the blood sugar levels drop below normal, which can lead to various symptoms such as dizziness, confusion, sweating, and even loss of consciousness. As a healthcare professional, I have encountered several difficult cases of low blood sugar, and I would like to share one of them.One of the most challenging cases I encountered was a middle-aged woman who presented with recurrent episodes of low blood sugar. She had a history of diabetes and was on insulin therapy. Despite following her prescribed treatment plan, she continued to experience frequent episodes of hypoglycemia. This was concerning as it significantly impacted her quality of life and posed a risk for severe complications.To unravel the mystery behind her recurrent low blood sugar, a thorough evaluation was conducted. This included reviewing her medication regimen, assessing her dietary habits, and investigating any underlying medical conditions that could contribute to the episodes. It was discovered that she had been skipping meals and not adhering to a consistent eating schedule. Additionally, her insulin dosage needed adjustment as her body's response to the medication had changed over time.To address her recurrent low blood sugar, a comprehensive management plan was developed. This involved educating the patient about the importance of regular meals and consistent carbohydrate intake. She was also advised to monitor her blood sugar levels more frequently and adjust her insulin dosage accordingly. Furthermore, she was referred to a dietitian who helped her create a personalized meal plan to ensure adequate nutrition while maintaining stable blood sugar levels.Over time, with the implementation of these interventions, the patient's episodes of low blood sugarsignificantly decreased. She reported feeling more energetic and experienced improved overall well-being. This case highlighted the importance of individualized care and the need to address not only the medical aspects but also the lifestyle factors that contribute to low blood sugar.中文回答：低血糖，也被称为低血糖症，是一种难以诊断和治疗的疾病。
低血糖是指血糖浓度低于正常范围，通常在成人空腹血糖浓度低于2.8mmol/L（50mg/dL），糖尿病患者血糖浓度低于3.9mmol/L（70mg/dL）时出现。
低血糖可能是由于多种原因引起的，包括胰岛素分泌过多、长时间未进食、升糖激素不足等。
在临床实践中，低血糖病例通常包括以下症状：交感神经兴奋：如饥饿感、出汗、颤抖、软弱无力、面色苍白、心率加快、头晕等。
脑功能障碍：如意识模糊、行为异常、视力障碍、答非所问、抽搐等。
精神状态改变：如情绪不稳定、焦虑、易怒等。
其他症状：如嗜睡、乏力等。
低血糖疑难病例讨论记录范文一、病例介绍。
（一）基本信息。
患者：[患者姓名]，男性，[X]岁。
（二）病史。
患者既往有[列举一些基础疾病，如2型糖尿病多年，一直口服降糖药控制血糖，还有高血压病史，长期服用降压药等]。
平时饮食不太规律，有时会因为忙就少吃一顿饭。
患者大约在[入院前具体时间]突然出现心慌、手抖、出汗、饥饿感明显，随后意识有些模糊，被家人紧急送至我院急诊科。
（三）入院检查情况。
1. 血糖。
在急诊科时测量指尖血糖为2.5mmol/L，立即给予50%葡萄糖注射液20ml静脉推注，患者症状稍有缓解。
2. 其他血液检查。
血常规：大致正常，白细胞、红细胞、血红蛋白等指标均在正常范围。
肝肾功能：肝功能正常，肾功能肌酐、尿素氮等也无异常。
胰岛素及C肽测定：空腹胰岛素水平偏高，C肽水平也高于正常范围，这有点奇怪，按说患者虽然有糖尿病，但是在低血糖的时候胰岛素不应该这么高。
3. 影像学检查。
腹部B超：肝脏、胆囊、胰腺等脏器未见明显异常。
没有发现胰腺有肿物之类的可能导致胰岛素异常分泌的情况。
二、讨论环节。
（一）住院医师A发言。
“这个患者啊，一开始我就觉得是个简单的低血糖，可能是因为他吃饭不规律，再加上吃着降糖药就低血糖了。
但是后来看到胰岛素和C肽的结果，我就有点懵了。
这就说明他体内胰岛素分泌有问题啊。
我想是不是他的降糖药吃多了，可是问了家属，家属说都是按照医嘱吃的，而且剂量也没有改变过。
难道是他的身体对降糖药太敏感了？可他之前一直吃着也没这样啊。
”（二）主治医师B发言。
“我觉得A说的有一定道理，但是没那么简单。
患者的胰岛素和C肽高，我们得考虑有没有胰岛素瘤的可能。
虽然B超没发现问题，但是有些小的胰岛素瘤B超可能看不到。
我们可以考虑做个增强CT或者磁共振成像（MRI）再看看胰腺的情况。
还有啊，他的糖尿病史也得重新评估一下，会不会他本来就不是单纯的2型糖尿病呢？说不定有其他特殊类型的糖尿病，比如说成人隐匿性自身免疫性糖尿病（LADA），这种糖尿病在病程中可能会出现胰岛素分泌异常的情况。
低血糖病例书写范文英文回答：Hypoglycemia, also known as low blood sugar, is a condition that occurs when the sugar levels in your blood drop below normal levels. This can happen for a variety of reasons, such as skipping meals, exercising vigorously without eating enough, or taking too much insulin or other diabetes medications.When a person experiences hypoglycemia, they may feel shaky, dizzy, sweaty, and have a rapid heartbeat. In severe cases, hypoglycemia can lead to confusion, seizures, and loss of consciousness. It's important to treat hypoglycemia promptly by consuming fast-acting carbohydrates, such as fruit juice, glucose tablets, or candy.If left untreated, hypoglycemia can be dangerous and even life-threatening. It's important for individuals with diabetes to monitor their blood sugar levels regularly andto always carry a source of fast-acting glucose with themin case of an emergency.中文回答：低血糖，也被称为低血糖，是指血液中的糖分水平低于正常水平的情况。
