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    Home > Active Ingredient News > Endocrine System > Mistakenly low blood sugar as alcohol poisoning, will be out of life!

    Mistakenly low blood sugar as alcohol poisoning, will be out of life!

    • Last Update: 2020-06-25
    • Source: Internet
    • Author: User
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    Drunk fell, the patient never woke up
    patient, male, 36 years oldHe was admitted to hospital for "three hours of ill-consciousness"3 hours ago the patient was found lying on the floor of their home, crying should not, push not moving, red-faced, breathing deep, exhaling air has a strong smell of alcohol, urine incontinencehave a history of alcoholism, and like to drink on an empty stomach, eat less food, often drunkDeny the history of diabetes and liver disease:T 36.8C, P 106times/min, R 22 times/min, BP 140/70mmHgcoma, two-sided pupil diameter 3mm, slow response to light, skin sdurdopha without yellow ingea, lip armor no purple, neck soft, neck veins without angerHeart (-), two lungs breathing clear, can smell and dry soundThe abdomen is flat and soft, and the liver and spleen are out of reachThe tendon reflexes of the limbs, the stimulus signs of the meninges (-), and the pathological reflexes were not inducedAuxiliary Examination:Blood Glucose 1.0mmol/L, Blood Alcohol 280mg/dl;Blood Routine: WBC 12.3 x 109/L, N 84%, L 12%, M 3%, E 1%, Hb 116g/L, Plt 90 x 109/L; arterial blood gas analysis: pH 7.33, PaCO2 40mmHg, HCO3- 20mmol/L, SB 2mmol/L; urine routine normal, urinary ketone (-); skull CT abnormal clinical diagnosis: acute alcoholism, alcoholic hypoglycemia treatment: immediately given intravenous glucose, naloxone After 1 hour blood sugar rose to 3.5mmol/L, 2 hours at 6.6mmol/L, and every hour after that, blood sugar is measured in the normal range after observation the next day check: blood biochemistry: glucose 4.1mmol/L, Na 132mmol/L, K-3.3mmol/L, ALT 74U/L, AST 174U/L, CK 1133U/L, CK-MB 56U/L, ChE 9 833U/L, hemoline 20 smol/L, hemopyridobuta acid 0.6mmol/L, blood lactic acid 0.8mmol/L; cerebrospinal fluid: pressure 110mm H2O, white blood cell 0, protein 0.32g/L, glucose 3.35mmo/L; lung CT: two lungs scattered in small flakes check the eGS on the third day after the observation: diffuse ripples Consider patients in the emergency room for 3 days still not awake, for further treatment of the income ward post-hospital examination : skull CT: large low density shadow of the left temporal lobe (Figure 1); 1 skull MRI: two-sided forehead pillow lobe visible length T2 (Figure 2), FLAIR is high signal abnormality (Figure 3) Figure 2 Figure 3 clinical final diagnosis: acute alcoholism, alcoholic hypoglycemia, alcoholic hypoglycemia, lung infection continue to supplement glucose with large doses of B vitamins, improve brain metabolism, fight infection, and support treatment for the disease was hospitalized for half a month and remained in a shallow coma Check the eEG: Full guide 3-6Hz low to medium amplitude slow-wave motion finally for financial reasons, the family asked to give up treatment and be discharged automatically Why does drinking cause hypoglycemia? the first thing we need to know is that there is no significant correlation between the magnitude of blood sugar reduction and the concentration of ethanol in blood in the case of alcohol-induced hypoglycemia alcoholhypoglycemia is usually associated with these factors: alcohol can inhibit liver glycogen synthesis, ethanol in the liver oxidation into acetaldehyde, acetic acid, a large number of coenzyme I (NAD) oxidation reduced to reduced coenzyme I (NADH), resulting in A reduction of NAD, so that the blood lactic acid, glycerin, amino acids can not be through the sugar isoerogenprocess process into glucose, blood sugar production is reduced, so blood sugar reduction; drinking, the body's epinephrine nerve seventy-enhancement of nerve excitement and cortisol function, consumption
    of excessive energy, glucose decomposition metabolism increases, blood sugar levels drop in plasma; long-term heavy drinking will cause hypothalamus-pituitary-adrenal axis dysfunction, sympathetic nervous system suppression, epinephrine hormone secretion, leading to a drop in blood sugar; Coupled with drinking very little or no, alcohol does not provide energy in itself, so it can also lead to lower blood sugar in addition, there is a more unusual and unusual situation, that is, after meal alcohol hypoglycemia, mostly after drinking about 1 to 5h, mainly due to food and ethanol mixing to stimulate a large amount of insulin production and patients are prone to hypoglycemia when they develop alcohol-based hypoglycemia this is because the brain itself has no reserves of glycogen, its energy is almost 100% dependent on the supply of glucose, so the brain is so dependent on glucose, the reserves of glucose can only be maintained for 30 minutes , even though transient hypoglycemia usually has no significant pathological changes in the brain, but recurrent, longer-lasting hypoglycemia can cause brain tissue congestion If hypoglycemia lasts more than 6 hours, brain cell degeneration is irreversible, with cerebral edema, central nervous damage, and varying degrees of nerve function damage how to tell the difference between alcoholism or alcoholism? When patients with acute alcoholism have hypoglycemic coma, because clinical manifestations are easily covered by intoxication, often ignored, which is one of the important causes of alcohol death so when we first visit a comatose patient, we must ask about the history of drinking Especially for people with a history of drinking, coma should be more vigilant, first of all to rule out whether or not to concurrent hypoglycemia, must not be caused by alcohol-induced brain suppression and ignore the possibility of low blood sugar and, because the clinical manifestations of hypoglycemia are more, can be simply manifested as central nervous dysfunction, accompanied by limb paralysis, convulsions, speech adverse symptoms are easy to be misdiagnosed as cerebrovascular disease, so for patients with neurodysfunction after drinking alcohol also consider the possibility of concurrent hypoglycemia the best way to tell whether a patient is purely alcoholic or low blood sugar, which is to detect blood sugar Therefore, it is recommended that clinicians routinely test blood sugar in case of symptoms and signs of the developing nervous system and even coma in patients with alcohol consumption, so as to confirm it early once diagnosed, you can first use 50% glucose solution 100 ml intravenous injection, and with other rehydration measures to dilute the patient's blood alcohol concentration, and then with diuretic and other drugs to alleviate the disease For patients with combined acute alcoholism, naloxone can relieve the central inhibition of alcoholism, shorten the time of coma, is a targeted drug of acute alcoholism Multi-Team Source: WhiteBall Eagle Medical Court
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