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foreword
forewordThe blood sugar was 19.
25mmol/L.
Without the symptomatic treatment of hypoglycemic, it suddenly dropped to 5.
75mmol/L one day apart.
Can the difference be reviewed? While confused, start to solve various puzzles
.
25mmol/L.
Without the symptomatic treatment of hypoglycemic, it suddenly dropped to 5.
75mmol/L one day apart.
Can the difference be reviewed?
case after
case afterThe patient, Nong, was admitted to the emergency department due to "head and face pain and bleeding for about 3 hours due to a traffic accident", and the head wound was bandaged to stop bleeding, intravenous infusion of mannitol and dexamethasone to reduce intracranial pressure, etc.
, and emergency wound debridement and suture Symptomatic treatment such as anti-tetanus, anti-infection, nourishing brain cells, reducing phlegm, and rehydration was given.
The emergency biochemical test measured blood sugar 19.
25mmol/L.
During this period, no hypoglycemic treatment was performed.
After admission, blood sugar was monitored again, and it was normal again.
Measured 5.
75mmol/L, why is there such a big difference in blood sugar between the two times?
2022.
3.
1 Emergency biochemical blood sugar measured 19.
25mmol/L↑
3.
1 emergency biochemical blood sugar measured 19.
25mmol/L↑ 2022.
3.
1 emergency biochemical blood sugar measured 19.
25mmol/L↑
On March 2, 2022, the blood glucose in the ward was measured to be 5.
75mmol/L↑
3.
2 ward monitoring blood sugar measured 5.
75mmol/L↑ 2022.
3.
2 ward monitoring blood sugar measured 5.
75mmol/L↑
case analysis
case analysisCommunicate with the clinic and ask the nurse whether the blood collection was not submitted in time.
The nurse replied that the blood glucose was reduced in vitro due to the consumption and degradation of blood sugar.
Check the patient's emergency urine routine test, the urine sugar was negative, and the emergency biochemical blood sugar was 19.
25mmol/L.
Whether the test is wrong, the blood re-examination result of the day is 18.
15mmol/L, and the test is wrong;
Whether the ipsilateral glucose-containing liquid was infused in the emergency blood draw, and compared the results of biochemistry and blood routine in the emergency department and the ward, the emergency results did not find that the ipsilateral infusion caused the dilution of the test results; follow-up communication with the clinic learned that the patient was monitored several times by the bedside Blood sugar is normal, and its glycosylated hemoglobin is also normal, so it is very likely to be the case - stress hyperglycemia
.
Emergency blood routine glucose negative (-) ↑
Emergency blood routine glucose negative (-) ↑ Emergency blood routine glucose negative (-) ↑Take out the emergency specimen and the re-examination result is still high↑
Taking out emergency specimens for re-examination is still high ↑ Taking out emergency specimens for re-examination results is still high↑Glycated hemoglobin results were normal↑
Glycated hemoglobin was normal ↑ Glycated hemoglobin was normal ↑Summarize
SummarizeThe patient's head and face are painful and oozing blood due to a car accident.
The patient in emergency rescue is in a state of stress at this time.
Under the stress state, the secretion of glucagon, epinephrine, cortisol, and growth hormone increases.
These hormones all have the effect of raising blood sugar.
resulting in hyperglycemia
.
increases.
These hormones all have the effect of raising blood sugar, which leads to hyperglycemia.
At the same time, the patients were treated with intravenous infusion of mannitol and dexamethasone to lower intracranial pressure.
The application of mannitol and hormones can inhibit insulin secretion, reduce insulin sensitivity, reduce the metabolic utilization of glucose, and also increase blood sugar
.
There is currently no unified understanding of stress hyperglycemia.
Generally, it is necessary to rely on medical history and blood sugar conditions to exclude the diagnosis.
In severe infection, fever, severe trauma, perioperative period, acute phase of cardiovascular and cerebrovascular disease, pain, anxiety, insomnia and other stressors In the state, the fasting blood glucose ≥ 6.
9 mmol/L, or the random blood glucose ≥ 11.
1 mmol/L measured twice or more at different times, and drug factors (such as glucocorticoids, etc.
), acute pancreatitis, hyperthyroidism, endocrine Secondary hyperglycemia caused by diseases such as tumors and radiotherapy can be diagnosed as "stress hyperglycemia"
.
Normal glycated hemoglobin (HbA1c) is used as the diagnostic standard.
HbA1c can better reflect the average level of blood sugar in the body for 2 to 3 months, and there is no need for fasting and blood collection at a specific time .
It is reliable to assess the level of blood glucose control in vivo over a longer period of time
.
HbA1c can be used as a differential diagnosis for stress hyperglycemia.
If the patient is only hyperglycemic, but the glycosylated hemoglobin is normal, it indicates that there may be stress hyperglycemia
.
Stress hyperglycemia is not diabetes in the true sense.
There are many mysteries behind the seemingly simple test numbers.
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