هيپوگلسيمي شديد ناشي از خطاي غيرعمد در بيمار غيرديابتي تحت بيهوشي عمومي: گزارش موردي

Iatrogenic severe hypoglycemia in a non-diabetic patient under general anesthesia: case report

زمينه و هدف: هيپوگليسمي وقتي بروز‌ مي‌كند كه غلظت پلاسماي گلوكز به زير mg/dl 70 برسد. معرفي‌بيمار: مرد 52 ساله‌اي شهريور 1395 با مراجعه به بيمارستان شهداي تجريش با تشخيص سنگ كليه كانديد عمل سنگ‌شكني از راه تونل پوستي شد. حين بيهوشي جراح درخواست تزريق ترانگزاميك اسيد كرد. ولي به‌اشتباه 100 واحد انسولين كريستال تزريق شد. علايم حياتي پايدار و قند خون به mg/dl 85 رسيد. سپس ml 50 محلول دكستروز 50% و انفوزيون دكستروز واتر 50% تجويز شد. در ريكاوري بيمار گلوكاگن دريافت كرد، ولي خوشبختانه حملات هيپوگليسمي ديده نشد. بيمار در 3 ساعت اوليه ورود به بخش مراقبت‌هاي ويژه، دچار حملات شديد هيپوگليسمي شد كه با تزريق دكستروز واتر 50% درمان و پس از ثابت شدن ميزان قندخون به بخش منتقل گرديد. نتيجه‌گيري: هيپوگليسمي اياتروژنيك نسبت به ساير علل هيپوگليسمي با مورتاليتي پايين‌تري همراه است. با مانيتورينگ دقيق و تشخيص به موقع مي‌توان از بروز عوارض وخيم جلوگيري كرد.

Background: Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining. Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward. Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.