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例1女,74岁,住院号22563。因间断双下肢及面部浮肿2年,咳嗽、咳痰,不能平卧1个月,于1990年11月19日入院。查体:BP22/12kPa,贫血貌,眼睑及双下肢浮肿,双肺底可闻及湿罗音。心率84次/min,无杂音。肝肋下3cm,移动性浊音(+)。空腹血糖19.3mmol/L。经临床及辅助检查诊为糖尿病合并肾病、冠心病、心衰、低蛋白血症,肺感染。给优降糖2.5mg1次/日口服及对症治疗。于服药后4小时出现大汗,心悸,呼吸32次/min。查血糖2.4mmol/L,给鲜桔汁20ml及少量饮食后症状缓解。8小时后突然昏迷,呼吸12次/min,压眶反射迟纯,两侧瞳孔等大,光反射迟钝,右侧鼻唇沟变浅,右侧肢瘫,肌力Ⅱ级,腱反射减弱,右侧巴氏征(+);查尿糖及尿酮体(一),血糖1.6 mmol/L。立即给50％葡萄糖120ml静推,后继以10％葡萄糖500ml维持静点,40分钟后患者神志转清,肢瘫及肌张力恢复,病理反射消失,血糖正常。诊断:优降糖引起低血糖致偏瘫。
Example 1 Female, 74 years old, hospital number 22563. Due to intermittent lower extremities and facial edema 2 years, cough, sputum, can not lie down for 1 month, was admitted to hospital on November 19, 1990. Examination: BP22 / 12kPa, anemia appearance, eyelid and lower extremity edema, both lungs can be heard and wet rales. Heart rate 84 beats / min, no noise. Liver ribs 3cm, mobility dullness (+). Fasting blood glucose 19.3mmol / L. Clinical and auxiliary examination diagnosed as diabetic nephropathy, coronary heart disease, heart failure, hypoproteinemia, lung infection. Give glibenclamide 2.5mg1 times / day oral and symptomatic treatment. 4 hours after taking medication sweating, palpitations, breathing 32 times / min. Check blood glucose 2.4mmol / L, 20ml of fresh orange juice and a small amount of diet to ease the symptoms. 8 hours after a sudden coma, breathing 12 times / min, pressure orbital reflex pure, bilateral pupil and other large, slow light reflex, the right nasolabial fold shallow, right limb paralysis, muscle strength Ⅱ, tendon reflex, Right side of the Pakistan’s sign (+); check urine and urine ketone body (a), blood glucose 1.6 mmol / L. Immediately to 50% glucose 120ml static push, followed by 10% glucose 500ml to maintain the static point, 40 minutes after the patient consciousness clear, limb paralysis and muscle tone recovery, pathological reflex, normal blood glucose. Diagnosis: glyburide hypoglycemia caused hemiplegia.