Hyperosmotic Hyperglycemic Crisis in a Nondiabetic Patient after Stroke

出血性腦中風併發高血糖危機

張志任(Chih-Zen Chang) ； 黃大謙(Tai-Chien Huang) ； 何俐寬(Lee-Kwong Ho) ； 許淑惠(Shu-Huei Hsu)

《南臺灣醫學雜誌》 4卷1期 (2008/03) Pp. 31-37

https://doi.org/10.6726/MJST.200803_4(1).0006

摘要

腦中風病人併發高血糖的比例並不少見。但是出血性腦中風病者併發高血糖，且發作前並無糖尿病的病史或就醫記錄，搜尋文獻紀錄，幾乎沒有記載。因此，本研究以回述性地紀錄一位五十二歲的男性，突發性左邊基底核出血（4.3X5.2X4.5 cm3）， 以往病史無糖尿病的記錄，緊急手術後，第一天至術後第三天指梢血糖測試一天四次，數值介於106至156 mg/dl間，於術後第四天改成一天測一次。患者於術後第十天，突發高血糖危症（血糖高至1224 mg/dl），且倂發意識喪失，冒冷汗，呼吸急促，高燒，旋接受氣管插管及胰島素治療，終於於術後第十五天，順利拔管出院。提出此一病例，重點在於對於高血糖的患者倂發腦中風，高血糖的監測頻率自然會提高，但是需要測多久？對於沒有高血糖的腦中風患者，高血糖的監測頻率及時間長短，是一門藝術亦是一門學問。本文病患術後第十天才發生高血糖危症，屬於非常少見，最可能的原因是壓力引起的內分泌失調，在加上缺水引起的，居多。因此，提出來共勉之。

關鍵字

出血性中風 ； 高血糖危症 ； 糖尿病

並列摘要

Hyperglycemic crisis has been found associated with higher mortality and disability in nondiabetic patients after stroke. However, the correlation of the hyperglycemia and stroke in a nondiabetic patient has not been clarified. This study recorded a nondiabetic patient encountered a hemorrhagic stroke and subsequent hyperglycemic crisis. A 52-year-old male patient had an episode of left cerebral hemorrhage(4×5×4 cm3). Emergent surgical intervention was given and the vital sign was stable in the stay at intensive care unit (7 days). At the 10th day, his consciousness statusl became stupor, associated with oligouria, dyspnea and high body temperature(39℃ ). Hyperosmolar hyperglycemia was impressed and his instant blood sugar level achieved 1224mg/dl. Thereafter, a continuous glucose monitoring and regular insulin administration was applied in this patient. It helped the nondiabetic patient overcome hyperglycemic crisis finally. On admission, the patient showed no evidence of diabetics; tracing his past annual health examination, he showed to be euglycemic. On the day of admission, his serum glucose level is 137mg/dl. In the early time point of phase (8h from stroke onset), the patient did not become hyperglycemic as predicted. The capillary finger prick test was performed continuously to the late phase (96h poststroke). If the subject showed postprandial hyperglycemic (≧ 200 mmg/dl), which can be corrected by oral antidiabetic agents or subcutaneous insulin, the frequency of serum sugar detection was decreased to examine the early fast serum sugar per day. Unfortunately, inadequate intake and extremely intake and output imbalance defer the recovery of this subject, and even resulted in a lethal hyperglycemic crisis. The serum sugar is 1224mmg/dl, iron of sodium is 174, and serum osmolarity showed 370. All the above data implied an impending crisis embraced this patient. The emergent endotracheal intubation and assistant ventilation as well as continuous insulin intravenous dripping combined with intensive serum sugar detection per 2h till the serum sugar returned to euglycemic. Analysis the occurrence of hyperglycemic crisis demonstrated that stress, preexisting diabetes, insular cortical ischemia, increasing age, infection predicted higher glucose values. Hyperglycemia is common in stroke patients, no matter who is diabetic or not. However, the onset of hyperglycemic crisis is rare and lethal to the patients. At 10th day post stroke, this patient encountered a life threatened hyperglycemic crisis, which always happened in early (14-16 h) and late (48-88 h) phases in nondiabetic as well as diabetic stroke patients but rare after 7 days. Treatment protocols with the frequency of glucose measurement and intensive glucose-lowering therapy for a minimum of 72 h poststroke need to be re-evaluated.

並列關鍵字

Hemorrhagic stroke ； hyperglycemic crisis ； diabetic