Be wary of these "pits" in the clinic, "hypoglycemia" is easy to confuse with these three diseases

Hypoglycemia is one

Familiarize yourself with the mechanisms of hypoglycemia

To avoid the misdiagnosis of hypoglycemia, familiarity with the mechanism of hypoglycemia is a prerequisite

Its main mechanisms are:

(1) The energy source of brain cells is mainly glucose, due to the blood-brain barrier and the physiological structure of the brain, the glucose storage of brain cells is limited, each gram of brain cells storage sugar 2.

(2) When hypoglycemia occurs, the sympathetic nervous system is excited, the patient's adrenaline release increases, and palpitations and sweating may occur; The secretion of catecholamines can cause the coronary arteries of patients to contract, reduce the oxygen supply of cardiomyocytes, and patients can exhibit arrhythmias; For cardiomyocytes, glucose is the main functional substance, and the demand is large, when the hypoglycemic myocardial function is insufficient, patients can have bradycardia and decreased conduction function; Hypoglycemia can induce potential ectopic excitatory foci in the myocardium, resulting in ectopic heart rates such as pretemporal contractions, atrial fibrillation, and supraventricular tachycardia, which can be misdiagnosed as coronary heart disease

Hypoglycemia misdiagnosed as "cerebrovascular disease"

The greatest

Although elderly hypoglycemia is similar to acute cerebrovascular disease, it mostly has low skin temperature, a long period of onset before or after meals, and hypoglycemia triggers, and should be targeted to observe and ask the medical history when receiving treatment, so as to provide important diagnostic basis

Misdiagnosis of hypoglycemia as "mental illness"

Some patients have a long history of diabetes or autonomic neuropathy, or take adrenergic receptor blockers, resulting in a sluggish sympathetic and adrenal medullary response, hypoglycemia without sympathetic involvement symptoms, but manifested as central nervous system dysfunction, convulsions, clinically easy to misdiagnose epilepsy and take antiepileptic drugs, causing pain and unnecessary economic burden
to patients.

Seizures may have loss of consciousness, impaired consciousness, etc.
, and seizures are repetitive, stereotyped and irregular, and their inter-seizure and episodic EEG is prone to specific abnormal waves (epileptic discharge), and there is generally no significant blood glucose reduction change
at the time of seizure.

The EEG between episodes of hypoglycemia is generally normal, and the onset period is dominated
by diffuse irregular slow waves.

In patients with hypoglycemia, the form of seizures is not exactly the same, the duration is not equal, and it is not as stereotyped as epilepsy symptoms, lasting about 1 to 2 minutes (except status epilepticus).

Misdiagnosis of hypoglycemia as "coronary heart disease"

Some patients have high risk factors and age of coronary heart disease, no obvious neurological signs, and cardiac manifestations are the mainstay, panic, chest tightness, sweating, and obvious changes in ST-T on the ELECTROCardiogram, and the first diagnosis is easy to misdiagnose coronary heart disease and atypical angina attacks
.

However, in addition to angina, palpitation, chest tightness symptoms, and ELECTROCardiographic changes, the diagnosis of coronary heart disease should also have the causes of coronary heart disease, exercise stress test (+), and coronary angiography coronary arteries with more than 75% narrowing to diagnose
.

Simple ECG ST-T changes are not diagnostic
.

Autonomic nerves, electrolytes, sympathetic hyperactivity and other factors can affect ECG ST-T changes; In addition, the timing of coronary heart disease attacks is not fixed, and the duration of the attacks generally does not exceed 15 minutes to alleviate; Sublingual nitroglycerin mostly resolves quickly, which helps to distinguish
hypoglycemia from accompanying cardiac symptoms.

Analysis of the causes of misdiagnosis

The complex clinical manifestations of hypoglycemia are the primary reason for misdiagnosis, followed by insufficient understanding of hypoglycemic encephalopathy
, which indicates that the understanding of hypoglycemia is not systematic.

Insufficient understanding of hypoglycemic encephalopathy, associated disease interference, lack of knowledge of hypoglycemic drug treatment, insufficient understanding of non-diabetic hypoglycemia and insufficient understanding of factors that increase hypoglycemic effects are mainly related to the lack of professional quality of medical personnel, which is also the main reason for
the misdiagnosis of hypoglycemia.

Secondly, the medical staff's sense of responsibility is not strong, which is manifested in the lack of careful collection of medical history, insufficient subjective attention to hypoglycemia, objective examination interference, insufficient clinical observation and effective mistreatment of
sugary drugs.

Prevention of misdiagnosis of hypoglycemia

The diagnostic criteria for hypoglycemia are blood glucose below 2.
8 mmol/L and present in a variety of ways, from asymptomatic to convulsions and coma
life-threatening.

Its occurrence is not only related to the degree of blood glucose reduction, but also the speed and duration of blood glucose decline and the individual's tolerance to drug
responses.

To avoid misdiagnosis, the following points should be noted:

(1) Strengthen the study of hypoglycemia and grasp its pathogenesis, etiology and clinical manifestations
.

(2) When receiving patients, they should ask in detail whether they have a history of diabetes, whether they have had similar reactions, understand their use of insulin or oral hypoglycemic drugs, as well as their recent diet and exercise
.

In particular, when encountering unexplained coma, the possibility of hypoglycemic coma should be considered first, and random blood glucose testing should be performed on such patients at the first time to improve the early diagnosis rate
of hypoglycemia.

(3) Strengthen the management of diabetic patients, closely monitor blood glucose, timely adjust the treatment plan, change the diet structure and reasonable exercise to reduce the occurrence of hypoglycemia, hospitalized patients generally monitor 5 or 8 points of blood glucose, monitoring of blood glucose before bedtime can avoid the occurrence of hypoglycemia at night, the elderly such as bedtime blood glucose is less than 6.
7mmol / L, need to adjust hypoglycemic drugs or appropriate meals
.

In addition, the upper limit of blood glucose should be appropriately relaxed for elderly patients, and the general fasting blood glucose < 7.
8mmol/L, and the postprandial blood glucose < 11.
1mmol/L<b12>.

(4) In the clinic, when encountering central nervous system insufficiency such as impaired consciousness, focal nerve symptoms, mental abnormalities and convulsive episodes in the elderly, peripheral blood glucose measurement should be performed quickly, and then decide whether to do cranial CT examination, which can improve the rapid diagnosis rate of the disease and avoid misdiagnosis
.

References:

[1] Jin Yue'e,Xu Jingzhi.
Clinical analysis of 16 cases of hypoglycemia misdiagnosis[J].
Chinese Medical Guidelines.
2014,12(27),236.

Shi Wenshuang.
Analysis of 15 cases of acute cerebrovascular disease with misdiagnosis of hypoglycemic nervous system symptoms[J].
Journal of Electrocardiogram (Electronic Edition).
2018.
01.

[3] Liu Hao, Rong Genman; Clinical analysis of the causes and misdiagnosis of diabetic hypoglycemia in the elderly[J].
Chinese Medical Guidelines,2016.
31.

[4] Qu Shuru.
Clinical treatment of emergency hypoglycemia[J].
Chinese Medical Guidelines.
2018(01).