Oral Glucose Combined with Short-Term Intravenous Nutrition for the Prevention of Hypoglycemia after Endoscopic Colorectal Polypectomy

Objective: To investigate the effect of oral glucose combined with short-term intravenous nutrition on the prevention of hypoglycemia after endoscopic colorectal polypectomy and to provide guidance for better management of such patients. Methods: 860 patients who underwent endoscopic colorectal polypectomy for colorectal polyps in the Department of Gastroenterology of the First Affiliated Hospital of Yangtze University from January 2020 to December 2021 were selected for the study. The patients were divided into experimental and control groups according to the random number table method, with 430 patients in each group. In the control group, 3 L of polyethylene glycol electrolyte dispersion was used for preoperative intestinal preparation and postoperative fasting was performed routinely for 24 h. Short-term intravenous nutrition support was provided by rehydration, and finger blood glucose was monitored at 1, 4, and 8 h after intravenous infusion or when there were symptoms such as panic and cold sweat;in the experimental group, oral glucose intervention was implemented on the basis of the control group. The incidence of postoperative hypoglycemia, quality of bowel preparation, and tolerance of patients during bowel preparation were compared between the 2 groups. Results: The incidence of postoperative blood glucose Conclusion: Based on the present study population, oral glucose combined with short-term intravenous nutrition can effectively prevent the incidence of hypoglycemia in patients after endoscopic colorectal polypectomy;however, this was limited to a single-center study and the number of cases was small.

Oral Glucose Combined with Short-Term Intravenous Nutrition for the Prevention of Hypoglycemia after Painless Endoscopic Gastric Polypectomy

Objective: To explore the application effect of oral glucose combined with short-term intravenous nutrition in preventing postoperative hypoglycemia after painless endoscopic gastric polyp resection, and to provide guidance for better management of patients undergoing such procedures. Methods: A total of 886 patients who underwent painless endoscopic gastric polyp resection in the Department of Gastroenterology, the First Affiliated Hospital of Yangtze University, from January 2020 to December 2021, were selected as the study subjects. According to the random number table method, they were divided into an experimental group and a control group, with 443 cases in each group. Patients in the control group were subjected to routine fasting and water restriction for 8 hours before surgery, and routine fasting for 24 hours after surgery. Short-term intravenous nutrition support was provided through fluid supplementation, and finger blood glucose levels were monitored at 1 hour, 4 hours, and 8 hours after completion of intravenous infusion, or when symptoms such as palpitations and cold sweats occurred. The experimental group received oral administration of 5% glucose solution (500 ml) 2 hours before surgery based on the procedures of the control group. The incidence of preoperative discomfort (hunger, thirst, and fatigue), residual gastric fluid volume, and postoperative hypoglycemia were compared between the two groups. Results: The incidence of postoperative blood glucose Conclusion: Based on the study population, oral glucose combined with short-term intravenous nutrition can effectively prevent the incidence of hypoglycemia in patients undergoing painless endoscopic gastric polyp resection. However, due to the limitations of a single-center study and a small number of cases, its feasibility needs to be further validated with more data from multi-center and large-sample cases.

Clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to NICU in a tertiary care center: A cross-sectional study

Objective:To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center.Methods:The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric.196 Newborn babies with blood glucose levels<45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021.Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases.Results:The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher(23.4%vs.8.4%)(P<0.05).Small for gestational age,low birth weight,respiratory distress syndrome,hypothermia,and endocrine disorders were risk factors.The death rate in asymptomatic hypoglycemia neonates was significantly higher(58%vs.39%)(P<0.05).Conclusions:The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality.It is important to take vigilance and timely interventions to address associated symptoms,particularly poor feeding,in the management of neonatal hypoglycemia.

Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia:A Promising Supportive Therapy

Objective To investigate the efficacy of raw corn starch(RCS)in clinical management of insulinoma-induced hypoglycemia.Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively,and analyzed the therapeutic effects of the RCS intervention on blood glucose control,weight change,and its adverse events.Results The study population consisted of 24 cases of insulinoma patients,7 males and 17 females,aged 46.08±14.15 years.Before RCS-supplemented diet,all patients had frequent hypoglycemic episodes(2.51±3.88 times/week),concurrent with neuroglycopenia(in 83.3% of patients)and autonomic manifestations(in 75.0% of patients),with the median fasting blood glucose(FBG)of 2.70(interquartile range[IQR]:2.50-2.90)mmol/L.The patients'weight increased by 0.38(IQR:0.05-0.65)kg per month,with 8(33.3%)cases developing overweight and 7(29.2%)cases developing obesity.All patients maintained the RCS-supplemented diet until they underwent tumor resection(23 cases)and transarterial chemoembolization for liver metastases(1 case).For 19 patients receiving RCS throughout the day,the median FBG within one week of nutritional management was 4.30(IQR:3.30-5.70)mmol/L,which was a significant increase compared to pre-nutritional level[2.25(IQR:1.60-2.90)mmol/L;P<0.001].Of them,10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment[3.20(IQR:2.60-3.95)mmol/L vs.2.15(IQR:1.83-2.33)mmol/L;P<0.001].Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management[3.50(IQR:2.50-3.65)mmol/L vs.2.20(IQR:1.80-2.60)mmol/L;P<0.001],but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG.No improvement in weight gain was observed upon RCS supplementation.Mild diarrhea(2 cases)and flatulence(1 case)occurred,and were relieved by reduction of RCS dose.Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports

BACKGROUND Glucose imbalance is common in total parenteral nutrition(TPN).Hypoglycemia seems to be less frequent than hyperglycemia,but it influences the clinical outcome to a greater extent.Therefore,it should be effectively prevented and treated.However,there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.CASE SUMMARY We present three patients with liver cell injury who developed severe hypo-glycemia during or after TPN infusion.The causes of severe hypoglycemia and glucose-raising strategies were discussed.According to the physiological charac-teristics of the hepatocellular injury,the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases.We simultaneously reduced the dose of insulin and fat emulsion,and increased the dose of glucose in TPN.The blood glucose level was restored to normal range and clinical symptoms were eliminated.CONCLUSION When hypoglycemia occurs during or after TPN in patients with hepatocellular injury,physicians need to simultaneously reduce insulin and fat emulsion,and increase glucose,and correct severe hypoglycemia in time to reduce its adverse consequences.

Hypoglycemia in diabetes:An update on pathophysiology,treatment,and prevention

Hypoglycemia is a common complication in patients with diabetes,mainly in those treated with insulin,sulfonylurea,or glinide.Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia.Episodes of hypoglycemia are associated with physical and psychological morbidity.The fear of hypoglycemia constitutes a barrier that impairs the patient’s ability to reach good glycemic control.To prevent hypoglycemia,much effort must be invested in patient education regarding risk factors,warning signs,and treatment of hypoglycemia at an early stage,together with setting personalized goals for glycemic control.In this review,we present a comprehensive update on the treatment and prevention of hypoglycemia in type 1 and type 2 diabetic patients.

Fasting for Laboratory Tests Poses a High Risk of Hypoglycemia in Patients with Diabetes: A Pilot Prevalence Study in Clinical Practice

Objective: Fasting for lipid profiles is a deeply-rooted tradition that is being revisited. In patients with diabetes, such fasting poses a risk of hypoglycemia, as observed in recent studies and case reports. This iatrogenic, overlooked, form of hypoglycemia has been referred to as Fasting-Evoked En-route Hypoglycemia in Diabetes (FEEHD). The objective of the study is to determine the prevalence of FEEHD in clinical practice. Methods: A two-page survey was administered to adults with diabetes on anti-diabetic medication(s). Patients were asked if they recalled having experienced hypoglycemia while fasting for laboratory tests (FEEHD) during the preceding 12 months. Results: Of 168 patients enrolled, 166 completed the survey, with a mean age of 55.3 (SD: 15.4) years. Seventy-nine (47.6%) were females. Of these 166 patients, 119 (71 %) had type 2 diabetes. Forty-five patients (27.1%) reported having experienced one or more FEEHD events. Notably, only 31.1% of the patients who experienced a FEEHD event informed their provider of the event, and only 40% of FEEHD events reportedly resulted in any subsequent provider-made medication change(s) to prevent future events. Conclusions: This is the first study of FEEHD prevalence in clinical practice, the results of which serve to increase awareness amongst clinicians about the occurrence of FEEHD. We believe that FEEHD appears to be overlooked by clinicians. The prevalence of FEEHD in clinical practice is strikingly high (27.1%). More concerning is the significant underreporting of FEEHD events by patients to their clinicians (31%). We hope this study will trigger further investigation to confirm these preliminary findings and modify practice guidelines.

Reading impairment after neonatal hypoglycemia with parietotemporo-occipital injury without cortical blindness:A case report

BACKGROUND Perinatal brain injury may lead to later neurodevelopmental disorders,whose outcomes may vary due to neuroplasticity in young children.Recent neuroimaging studies have shown that the left parietotemporal area(which includes the left inferior parietal lobe)is associated with phonological awareness and decoding skills,which are essential skills for reading acquisition in children.However,the literature on the effect of perinatal cerebral injury on the development of phonological awareness or decoding ability in childhood is limited.CASE SUMMARY We report the case of an 8-year-old boy who presented with reading difficulty following a perinatal injury in the parieto-temporal-occipital lobes.The patient was born at term and was treated for hypoglycemia and seizures during the neonatal period.Diffusion-weighted brain magnetic resonance imaging on postnatal day 4 revealed cortical and subcortical hyperintensities in the parieto-temporo-occipital lobe.At the age of 8 years,physical examination was unremarkable,aside from mild clumsiness.Despite occipital lobe injury,the patient had adequate visual acuity,normal eye movement,and no visual field defects.Full-scale intelligence quotient and verbal comprehension index on Wechsler Intelligence Scale for Children-Fourth Edition were 75 and 90,respectively.Further assessment revealed adequate recognition of Japanese Hiragana letters.However,he had significantly slower reading speed in the Hiragana reading test than control children.The phonological awareness test revealed significant errors(standard deviation+2.7)in the mora reversal task.CONCLUSION Patients with perinatal brain injuries in the parietotemporal area require attention and may benefit from additional reading instructions.

Recurrent ciprofloxacin induced hypoglycemia in a non-diabetic patient:A case report

BACKGROUND Fluoroquinolones are a class of broad-spectrum antimicrobials used for various bacterial infections.Frequent use of fluoroquinolones has been questioned due to severe associated adverse effects,including dysglycemia(hypoglycemia or hyperglycemia)due to an alternation in glucose metabolism.Recent clinical trials showed the association of poor clinical outcomes with hypoglycemia in critically ill patients without diabetes.Many predisposing factors worsen fluoroquinolone-induced hypoglycemia,including diabetes,concomitant medication use like sulfonylureas or insulin,renal disease,and the elderly.CASE SUMMARY We report a case of recurrent hypoglycemia after ciprofloxacin initiation for a 71-year-old,non-diabetic,critically ill patient despite the presence of total parenteral nutrition and nasogastric tube feeding.The adverse drug reaction probability(Naranjo)scale was completed with a probable adverse drug reaction.The hypoglycemia resolved entirely after ciprofloxacin discontinuation.CONCLUSION Although ciprofloxacin-induced hypoglycemia is rare,special consideration is needed for the elderly due to their higher susceptibility to adverse side effects.

甲泼尼龙致重症肌无力患者严重低血糖的病例分析

1例50岁男性重症肌无力患者,先后给予溴吡斯的明片改善肌无力症状,甲泼尼龙片、吗替麦考酚酯胶囊抑制免疫,奥美拉唑肠溶片和碳酸钙D_(3)片预防激素相关不良反应等治疗。患者无糖尿病史,入院后测空腹血糖4.92 mmol/L。甲泼尼龙片治疗1周后,空腹血糖降至3.56 mmol/L。甲泼尼龙片治疗11 d后,空腹血糖低至2.80 mmol/L。排除其他药物后,考虑低血糖由甲泼尼龙引起的可能性大。因病情需要,且患者未诉大汗、心悸等低血糖症状,未予停药处理。随访2个月,患者甲泼尼龙逐渐减量,多次复查,血糖逐渐恢复至正常范围。

维持性血液透析患者肌少症现状及影响因素分析

目的探究维持性血液透析(MHD)患者肌少症发生的现况,并分析其影响因素。方法采用便利抽样法选取2023年10月至2024年1月在安徽医科大学第二附属医院血液净化中心接受治疗的MHD患者为研究对象,采用一般资料调查表、改良定量主观整体评估问卷(MQSGA)、国际体力活动短问卷(IPAQ-SF)、慢性病管理自我效能量表(SES6)以及生物电阻抗技术对患者进行调查评估。结果共纳入167例MHD患者,其中75例患者(44.91%)患有肌少症,发生率较高。二元logistic逐步回归分析结果显示,年龄、基础代谢率、慢病管理自我效能是MHD患者发生肌少症的影响因素(均P<0.05)。结论MHD患者肌少症的发生率处于较高水平,现况较为严峻。临床医护人员应重视该人群的肌少症早期筛查工作,应针对影响因素及时制订个性化强、有针对性的干预措施,以预防或减缓肌少症的发生、发展,降低肌少症的发生率。

4R危机管理理论在结肠镜围检查期低血糖风险管理中的应用

目的探讨4R危机管理理论在结肠镜诊疗围检查期患者低血糖风险管理中应用的效果。方法采用便利抽样法,选择2022年3-12月在青岛市某三级甲等医院消化内科住院的372例行结肠镜诊疗的患者为对照组,采用结肠镜诊疗围检查期常规低血糖管理方法;选择2023年1-10月住院的372例行结肠镜诊疗的患者为观察组,实施基于4R危机管理理论的低血糖管理方案。比较2组患者结肠镜诊疗围检查期低血糖发生率、护士对结肠镜诊疗围检查期低血糖处置规范环节达标率、低血糖相关不良事件或并发症发生率的差异。结果观察组患者低血糖发生率低于对照组,护士对观察组患者低血糖处置规范环节达标率高于对照组,差异均具有统计学意义(P<0.05或P<0.001),2组患者低血糖相关不良事件或并发症发生率差异无统计学意义(P>0.05)。结论4R危机管理理论应用于结肠镜诊疗围检查期患者的低血糖管理中,能够有效降低患者低血糖发生率,提高护士对结肠镜诊疗围检查期低血糖处置正确率,值得在临床推广应用。

母婴同室护士对新生儿低血糖管理的认知现况调查

目的:了解母婴同室护士对新生儿低血糖管理的认知情况。方法:于2018年12月1日—2019年2月28日选取首都医科大学附属北京妇产医院母婴同室的121名护士作为研究对象,采用自行设计的调查问卷对护士进行调查。结果:121名护士中,所有护士均认为需要定期学习新生儿低血糖的相关知识,80.17%(97/121)的护士通过医院培训获取新生儿低血糖相关知识,80.17%的护士希望由新生儿科医师定期开展新生儿低血糖相关知识培训。护士对不同新生儿低血糖问题的认知正确率差异较大,为3.31%~95.87%,且工作年限≥5年的护士“您认为新生儿低血糖主要损害哪个脏器”“您认为母亲发生妊娠糖尿病的新生儿为什么容易发生低血糖”条目认知正确率高于工作年限<5年的护士,差异均有统计学意义(P<0.05)。结论:母婴同室护士,尤其是工作年限<5年的护士,对新生儿低血糖相关知识的认知相对不足,医院定期开展针对性培训十分必要。

新生儿低血糖风险预测模型的构建及效果验证

目的构建新生儿发生低血糖临床风险因素及构建预测模型,为早期识别新生儿低血糖提供理论参考。方法选取2020年1月—2022年1月南京市某医院1330例新生儿为研究对象,按7:3分为建模组(n=931)、验证组(n=399)。利用Logistic回归构建模型,Hosmer-Lemeshow、ROC等评价拟合优度、预测效果。结果新生儿低血糖发生率在建模组与验证组中分别为12.57%(117/931)、12.78%(44/399),二者之间比较差异无统计学意义(P>0.05)。母亲合并糖尿病、母亲肥胖、孕期及哺乳期服用β受体阻滞剂药物、产前使用皮质类固醇类药物、小于胎龄、血糖检测方式6个因素是独立影响因素。建模组模型ROC曲线下面积0.893(95%CI:0.855~0.931,P=0.000),H-L检验结果为P=0.155,验证组曲线下面积占比0.847(95%CI:0.828~0.9876,P=0.000),H-L检验结果P=0.401。结论本模型预测效果良好,可有效预测新生儿低血糖并划分层级,为新生儿低血糖的临床护理提供理论依据。

曲马多诱导的低血糖的临床特征分析

目的:探讨曲马多诱导的低血糖的临床特点。方法:通过检索中英文数据从建库起至2023年4月28日,收集曲马多诱导的低血糖的病例报告。结果:20例患者被纳入,中位年龄为50岁(4,88)。低血糖发生在给药后1 h~23 d,血糖的中位值为2.25 mmol/L(0.22,3.3),曲马多的中位日剂量为300 mg(1.53,14000)。临床主要表现为昏迷(12例),多器官功能衰竭(7例),心肺骤停(7例),癫痫发作(4例),嗜睡(3例)和出汗(3例)等。6例患者报告了曲马多血药浓度,中位值为3.56 mg/L(0.47,9.4)。20例患者停用曲马多,给予对症支持治疗后,16例患者恢复,1例患者中度脑功能障碍,3例患者死亡。结论:曲马多诱导的低血糖可发生在给药后1 h~23 d,临床可表现为自主神经系统症状和神经低血糖症状,以神经低血糖症状为主。停用曲马多后大部分患者低血糖可恢复正常,严重者可死亡。

品管圈活动在降低内镜黏膜切除术术后48 h内低血糖发生率中的应用效果

目的探讨品管圈活动在降低内镜黏膜切除术(EMR)术后48 h内低血糖发生率中的应用效果。方法回顾性选取2023年4月至9月在首都医科大学附属北京世纪坛医院消化内科住院行EMR的胃肠息肉患者600例作为研究对象。将未实施品管圈(2023年4月至6月)的325例患者作为对照组,将实施品管圈(2023年7月至9月)的275例患者作为观察组。对照组按照常规护理进行管理,观察组在对照组的基础上开展品管圈活动。比较两组患者EMR术后48 h内低血糖的发生率及影响因素、生命质量评分的差异,分析开展品管圈活动在降低ERM术后48 h内低血糖中的实践成果。结果观察组低血糖发生率为4.4%,明显低于对照组(10.8%),差异有统计学意义(P<0.05)。影响低血糖发生率的因素中,观察组输液不合理、摄入不足的患者比例分别为0.7%、1.5%,均低于对照组(4.3%、4.9%),差异均有统计学意义(P<0.05)。干预后,观察组患者生理功能、生理职能、躯体疼痛、一般健康状况、心理健康、精力、社会功能、情感职能评分分别为(86.94±7.32)、(84.18±7.03)、(83.00±5.96)、(82.91±6.39)、(80.42±6.11)、(78.45±7.35)、(82.69±6.72)、(80.71±6.17)分,均明显高于对照组[(81.77±11.67)、(78.09±10.97)、(76.50±9.64)、(76.75±9.86)、(75.80±7.30)、(72.38±9.97)、(76.86±9.97)、(75.94±7.61)分],差异均有统计学意义(P<0.05)。通过此次品管圈活动,圈员们在品管圈手法掌握程度、发现问题能力、个人素质、责任心、组织协调能力、自信心、团队合作精神等方面都取得了进步。结论通过开展品管圈活动,规范了EMR的护理流程,降低了EMR术后48 h内低血糖的发生率,提升了护理人员的专业知识水平、品管圈的手法运用能力和团队协作及质量管理能力。

糖尿病合并轻度认知功能障碍患者亚群分类研究

目的探索糖尿病合并轻度认知功能障碍患者的潜在分类,以识别各类患者特征,为分层管理提供参考。方法采用蒙特利尔认知评估量表、精神简明状态量表、糖尿病自我管理量表对235例糖尿病合并轻度认知功能障碍患者进行调查。根据患者认知功能和自我管理特征对患者进行系统聚类确定分类数,再采用K-means进行患者分类研究及特征分析。结果糖尿病合并轻度认知功能障碍患者分为高认知低管理型、低认知低管理型、高认知型高管理和低认知高管理型4类;不同文化程度、来源、医保类型、个人月收入、低血糖发生频率患者的类别分布比较,差异有统计学意义(均P<0.05)。结论糖尿病合并轻度认知功能障碍患者的认知功能及自我管理能力存在异质性。建议医护人员在对患者分类的基础上,应充分考虑不同类别的特征,为患者制定个性化治疗护理方案,以预防疾病进一步发展。

恶性胰岛素瘤多发肝转移一例

恶性胰岛素瘤是疑难罕见的神经内分泌肿瘤之一,常合并远处转移,其中以肝转移最常见,预后多不佳。本文报道1例恶性胰岛素瘤多发肝转移病例。患者男性,70岁,因“发作性意识障碍4个月余”入院,监测血糖发现其空腹、餐后及夜间均反复出现低血糖。胰腺灌注CT及肝脏动态增强MRI发现胰头钩突部占位、肝内多发转移灶,经皮肝穿刺活检病理证实为胰岛素瘤。经多学科讨论后,分期行肝内动脉介入栓塞及射频消融治疗,同时联合依维莫司治疗。复查增强CT可见部分肝转移灶缩小。患者规律加餐,血糖逐渐上升并维持在正常水平。本文讨论该病例的临床特征及多学科协作诊疗经过,旨在为恶性胰岛素瘤患者的临床综合诊治提供经验。

Ⅰa型糖原贮积症临床特征分析

目的总结成人与儿童糖原贮积症(glycogen storage disease,GSD)Ⅰa型的临床特征,提高临床医生对成人GSDⅠa型的认识。方法纳入2010至2023年在复旦大学附属中山医院住院的GSDⅠa型患者共10例,其中成人组(19~36岁)5例、儿童组(0.5~11岁)5例,比较两组患者临床表现及生化特点。结果成人组和儿童组均有高三酰甘油血症、高尿酸血症、高乳酸血症;成人组以肝腺瘤(5例)、痛风(4例)表现更明显,儿童组以低血糖(3例)、肝肿大(4例)及生长发育迟缓(3例)为主要表现。结论GSDⅠa型患者常有代谢异常综合征,主要为高三酰甘油血症、高尿酸血症、高乳酸血症,其中成人患者常合并肝腺瘤,可表现为低血糖或接近正常低值的空腹血糖,上述临床表现组合可作为其诊断依据。

桦褐孔菌产降血糖活性物质分批发酵动力学研究

该研究通过液体深层发酵培养桦褐孔菌菌丝体的方式,研究桦褐孔菌发酵产具有降血糖活性代谢产物过程中不同初始葡萄糖添加量与菌丝体生长、桦褐孔菌基质消耗及降血糖代谢产物形成之间随培养时间变化的规律并建立分批发酵动力学模型。结果表明,桦褐孔菌菌丝体生长及降血糖活性代谢产物的形成在以30 g/L葡萄糖为碳源时最佳,与20 g/L葡萄糖为碳源的初始条件相比生物量提高了10.87%,最大生长速率提高了11.9%,最大比生长速率提升了19.3%,降血糖活性代谢产物形成的最大速率以及最大比形成速率分别提升了27.9%、50.57%,此时发酵液对α-葡萄糖苷酶抑制率达到最高89.82%,且此时的最大基质消耗速率均高于其他组。