临床需重视血糖重度异常对血钠测定值的干扰

Influence of Severe High Blood Glucose on Detection Value of Serum Sodium

目的总结血糖重度异常对血钠测定值干扰的诊治体会,并分析误诊原因,以减少误诊误治。方法结合相关文献对我院收治的2例血糖重度异常对血钠测定值干扰的临床资料进行回顾性分析。结果例1因昏迷10 h入院,初诊考虑脓毒性休克,完善实验室检查后诊断糖尿病酮症酸中毒昏迷,大量补充0.9%氯化钠注射液和小剂量胰岛素后血糖未降,考虑因胰岛素抵抗造成的持续高血糖,并继发高钠、高氯血症,予大剂量胰岛素及换用葡萄糖溶液补液后病情控制。例2因间断低热2个月,呼吸困难加重伴意识不清1 h入院,实验室检查示极高血糖和中度低钠血症,初诊先后考虑为哮喘及肺栓塞,后经血管造影否定初始诊断,会诊考虑到高血糖可致低血钠,实际血浆渗透压可能明显增高,诊断为糖尿病非酮症高渗状态,予针对性治疗后病情好转。结论对血糖重度异常的急危重症患者要注意血钠的显著改变,了解血糖与血钠异常的病理生理机制对临床诊治有重要的指导意义。

Objective To summarize the experience of diagnosis and treatment about the blood glucose affecting de- tection value of serum sodium and to analyze the causes of misdiagnosis to prevent misdiagnosis and mistreatment. Methods The clinical data of 2 eases with abnormal serum sodium affected by severe blood glucose in our hospital were retrospectively analyzed with a review of related literature. Results The first case suffered from coma for 10 h during the infusion for the left toe injury with the initial diagnosis of septic shock, and the diabetic ketoacidosis coma was diagnosed after the laboratory study. The blood glucose was not reduced with the hypernatremia emerging after the large dose of supplementary saline and small dose of regular insulin were given. The sustaining high blood glucose due to the insulin resistance plus the secondary high blood sodium raised the blood osmotic pressure sharply. After large dose of insulin, the hypertonic condition was con- trolled. The second case suffered from a intermittent low fever for 2 months, and dyspnea with unconsciousness for 1 h. The laboratory examination showed severe high blood glucose and moderate hyponatremia, and asthma was considered with pulmo- nary embolism. After the pulmonary artery and coronary artery angiography check-up, no obvious abnormality was found, re- consultation was made and it was believed that the high blood sugar might cause low sodium, the actual plasma osmotic pres- sure of this patient might be increased, and the diagnosis of diabetic nektonic hyperosmolar state was considered. Then the pa- tient＇s condition improved markedly after the targeted treatment. Conclusion Severe abnormal blood glucose may have a sig- nificant impact on serum sodium, and improved awareness of its pathophysiological mechanisms has some important guiding significance for clinical diagnosis and treatment.