低血糖和高血糖危象

Hypoglycemia crisis and hyperglycemia crisis

低血糖与高血糖危象是PICU最常见的内分泌及代谢急危重症。低血糖危象系因血糖水平过低(<2.2 mmol/L)和(或)血糖下降过快导致,临床出现脑功能受损和自主神经兴奋性异常为主要表现的综合征,严重者可致永久性神经系统损害甚至死亡。早期识别低血糖危象,及时输注葡萄糖是改善预后的关键。高血糖危象则因血糖水平异常增高(>11 mmol/L)导致,临床主要表现为糖尿病酮症酸中毒和高血糖高渗状态两种类型。糖尿病酮症酸中毒和高血糖高渗状态的治疗原则包括:尽快补液以恢复血容量、控制血糖、纠正电解质及酸碱平衡失调、积极寻找并消除诱因和防治并发症。脑水肿和渗透性脱髓鞘综合征是高血糖危象最严重的致死性并发症,尽早识别与积极处理有利于降低病死率。

Hypoglycemia crisis and hyperglycemia crisis are the most common endocrine and metabolic emergencies in PICU.Hypoglycemic crisis is caused by low blood glucose level(<2.2 mmol/L)and/or rapid reduction in blood glucose,which leads to autonomic neurogenic symptoms and central nervous system injury,even causes permanent brain injury and death.Early identification and timely glucose infusion are the key to improving prognosis.Hyperglycemic crisis is caused by abnormally increased blood glucose levels(>11 mmol/L),including diabetic ketoacidosis and hyperglycemic hyperosmolar state.The treatment principle of diabetic ketoacidosis and hyperglycemic hyperosmolar state include rapid fluid resuscitation to restore blood volume,control blood glucose,correct electrolyte and acid-base balance disorders,discover and removal of incentives and prevent complications.Cerebral edema and osmotic demyelination syndrome are the most fatal complications of hyperglycemic crisis.Early identification and active treatment can reduce the mortality.