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男患,66岁。因糖尿病合并肺部感染入院。伴有呕吐。入院时血糖13mmol/L,予以胰岛素控制血糖后病情稳定,查血糖8.9mmol/L,即停胰岛素改用美吡达10mg,日3次,共服30mg。当晚17时突然出现昏迷、口角右斜、左侧肢体偏瘫、颈强直、双侧巴氏征(+)、血压23/12kPa,考虑脑血管意外。一小时后血糖1.3mmol/L疑为低血糖反应,静注50%葡萄糖60ml,5分钟后神志转清,口齿清楚、四肢活动自如。续用5%葡萄糖静滴。四小时后再次出现昏迷、四肢抽搐表现。查血糖1.6mmol/L,再予50%葡萄糖60ml后神志转清,继以10%葡萄糖静滴维持。24小时查血糖5.4mmol/L,次晨血糖
Male suffering, 66 years old. Due to diabetes with pulmonary infection admitted. Accompanied by vomiting. Admission blood glucose 13mmol / L, to be stable after insulin control blood sugar, check blood sugar 8.9mmol / L, that is, to stop insulin infusion of pyridaben 10mg, 3 times a day, a total of 30mg. 17 o’clock that night a sudden coma, right angle diagonal, left limb hemiplegia, neck stiffness, bilateral Pakistan’s sign (+), blood pressure 23 / 12kPa, consider cerebrovascular accident. An hour after the blood glucose 1.3mmol / L suspected hypoglycemic reaction, intravenous injection of 50% glucose 60ml, 5 minutes after the consciousness to clear, articulate, limbs freely. Continue with 5% glucose infusion. Four hours later, there was a coma and convulsions in the limbs. Check the blood glucose 1.6mmol / L, and then to 50% glucose 60ml mind clear, followed by 10% glucose intravenous maintenance. 24 hours check blood sugar 5.4mmol / L, next morning blood sugar