• 제목/요약/키워드: hypoglycemia.

검색결과 211건 처리시간 0.026초

119구급대원의 저혈당 환자에 대한 병원 전 응급처치현황과 개선방안 (Prehospital Treatments of the Patient with Hypoglycemia by 119 Emergency Medical Technicians - Analysis of the Current Data and Survey -)

  • 안희정
    • 한국응급구조학회지
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    • 제14권1호
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    • pp.31-46
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    • 2010
  • This study was intended to analyze the clinical characteristic of the patient with hypoglycemia and the status of prehospital treatments by 119 emergency medical technicians well as the cause of inappropriate emergency treatment by 119 emergency medical technicians in a bid to seek the measures for improvement, thereby enhancing the emergency medical services before medical treatment at hospital. Examination of the daily work log on 430 patients suffering with hypoglycemia who were sent to the university hospital in Gyunggi-Province by 119 emergency medical technicians, beginning on Jan 1, 2004 till Dec 31. 2008 was carried out and the survey of 206 119 emergency medical technicians working at the region of Gyunggid-Province was conducted from Sep 19 through Oct 6, 2009. Evaluation of the frequency and percentage and ANOVA analysis using SPSS WIN 14.0 program was carried out. In view of the examination of daily emergency work log and questionnaire, prehospital treatment for the patients with hypoglycemia needs to be further improved in general, and to provide the emergency treatment in accurate and timely manner, improvement of the system such as assignment of licensed rescue members and development of protocol that will replace the medical consultant system, mandatory emergency treatment, constant and efficient training and maintenance of emergency rescue records shall be implemented, and furthermore, social recognition to 119 emergency medical technicians shall be improved to encourage them to perform more positive way and manner.

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고령자에서 Sulfonylureas와 항균제의 병용투여 현황 (Concurrent Use of Sulfonylureas and Antimicrobials of the Elderly in Korea: A Potential Risk of Hypoglycemia)

  • 이세라;옥미영;김현아
    • 한국임상약학회지
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    • 제28권3호
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    • pp.188-193
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    • 2018
  • Background: Previous studies have noted that the simultaneous use of sulfonylureas and antimicrobials, which is common, could increase the risk of hypoglycemia. In particular, an age of 65 years or older is a known risk factor for sulfonylurea-related hypoglycemia in hospitalized patients. Therefore, we performed this study to determine the potential risk of hypoglycemia from the concurrent use of antimicrobials and sulfonylureas. Methods: We performed a cross-sectional study on the National Health Insurance Service-National Sample Cohort from 2013. The eligibility criteria included patients of 65 years of age or older taking a sulfonylurea with 25 different antimicrobials. Different risk ratings of severity in drug-drug interactions (potential DDIs), level X, D, or C in Lexi-$Interact^{TM}$ online, and contraindicated, major, or moderate severity level in $Micromedex^{(R)}$ were included. SAS version 9.4 was used for data analysis. Results: A total of 6,006 elderly patients with 25,613 prescriptions were included. The largest age group was 70 to 74 (32.7%), and 39.7% of patients were men. The mean number of prescriptions was 4.3 per patient. The most frequently used antimicrobials were levofloxacin (6,583, 25.7%), ofloxacin (6,549, 25.6%), fluconazole (4,678, 18.0%), and ciprofloxacin (2,551, 9.8%). Among sulfonylureas, glimepiride was prescribed most frequently, followed by gliclazide, glibenclamide, and glipizide. Conclusion: Of the antimicrobials with a high potential of hypoglycemia, levofloxacin, ofloxacin, fluconazole, and ciprofloxacin were used frequently. Thus, the monitoring of clinically relevant interactions is required for patients concurrently administered sulfonylureas and antimicrobials.

간 0형 당원축적병의 임상 표현형과 식사관리 (Clinical Phenotypes and Dietary Management of Hepatic Glycogen Storage Disease Type 0)

  • 신영림
    • 대한유전성대사질환학회지
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    • 제23권2호
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    • pp.8-14
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    • 2023
  • 간 당원축적병 0형은 glycogen synthase 2 유전자에 부호화되어 있는 간 당원 합성효소의 결핍으로 비정상적으로 당원 생성이 되는 상염색체 열성 유전 질환이다. 당원축적병 0형의 임상 양상은 공복시에 고케톤혈증 저혈당증을 나타내고 식사후 고혈당과 고젖산혈증을 보인다. 당원축적병 0형은 현재까지 적은 수만 보고되었는데 증상이 경하거나 심한 저혈당이 드물고 또는 무증상이거나 나이가 듦에 따라 점차 증상이 사라지는 양상을 보이기 때문에 진단을 놓치는 경우가 있을 것으로 생각된다. 필수적 치료 전략은 포도당신생성을 자극하기 위해 고단백 식사, 낮동안 저혈당을 방지하기 위해서 잦은 식사 횟수, 밤 동안 천천히 포도당을 방출하기 위해 생옥수수전분가루 같은 복합 탄수화물을 먹는 것이다. 당원축적병 0형은 예후는 좋고 적절한 치료를 하면 정상적으로 성장하며 합병증도 발생하지 않는다. 성인이 될수록 심한 저혈당은 보이지 않게 되지만 지속적인 식사 관리는 필요하다.

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장쇄 수산화 아세틸코에이 탈수소효소 결핍증에 대한 고찰 (Very Long Chain Acyl-coenzyme A Dehydrogenase Deficiency: A Review of Pathophysiology, Clinical Manifestations, Diagnosis, and Treatment)

  • 강석진
    • 대한유전성대사질환학회지
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    • 제22권1호
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    • pp.21-27
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    • 2022
  • Very long-chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency (VLCADD) leads to a defective 𝛽-oxidation, specifically during prolonged fasting, infection, or exercise. Patients with VLCADD usually suffer from cardiomyopathy, hypoketotic hypoglycemia, hepatic dysfunction, exercise intolerance, muscle pain, and rhabdomyolysis, and sometimes succumb to sudden death. VLCADD is generally classified into three phenotypes: severe early-onset cardiac and multiorgan failure, hypoketotic hypoglycemia, and later-onset episodic myopathy. Diagnostic evaluation comprises acylcarnitine analysis, genetic analysis, and VLCAD activity assay. In the acylcarnitine analysis, the key metabolites are C14:1, C14:2, C14, and C12:1. A C14:1 level >1 mmol/L strongly suggests VLCADD. Various treatment recommendations are available for this condition. Dietary management includes decreasing fat content, increasing medium-chain triglyceride levels, and decreasing fasting periods. Supplementation with L-carnitine is controversial. Triheptanoin (a seven-carbon fatty acid triglyceride) treatment demonstrates improvement of cardiac functions. Bezafibrate may improve the quality of life of patients with VLCAD.

반복적인 저혈당으로 엑솜 시퀀싱을 통해 31개월에 진단된 Citrin 결핍증 1례 (A Case of Citrin Deficiency Presenting with Recurrent Hypoglycemia: Diagnosed by Targeted Exome Sequencing)

  • 김치우;황정윤;양아람;김진섭;이태헌;장자현;조성윤;진동규
    • 대한유전성대사질환학회지
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    • 제17권2호
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    • pp.69-76
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    • 2017
  • Citrin 결핍증은 요소회로 이상 질환 중 하나로, 7q21.3에 위치한 SLC25A13 유전자에 돌연변이로 발생하는 상염색체 열성 유전질환이다. 세 가지 표현형 중에 신생아 간내 담즙 정체형, 제 2형 시트룰린혈증은 잘 알려졌지만, 성장부진과 이상지질혈증형은 최근에 밝혀지고 있는 표현형으로 아직 우리나라에 보고된 적이 없다. 성장부진과 이상지질혈증형에서는 경미할 수는 있으나 식욕감소, 피곤함, 성장부진, 저혈당, 시트룰린 상승, 이상지질혈증, 젖산염/피루브산염 상승과 같은 이상이 관찰될 수 있다. 또한 저혈당으로 내원하였을 때 일반적인 검사로는 원인 규명이 어려울 수 있다. 저자들은 생후 30개월에 반복적인 저혈당으로 내원하여 소변 유기산 분석, 호르몬 검사와 같은 대사 이상 검사에서 명확한 특정 진단명이 의심되지 않아, 생후 31개월에 targeted exome sequencing을 통해 복합이형접합 SLC25A13 유전자 돌연변이[c.852_855del (p.Met285Profs*2), c.1177+1G>A]를 발견하여 성장부진과 이상지질혈증으로 발현한 citrin 결핍증을 우리나라에서 최초로 진단하여 보고하는 바이다.

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저혈당을 경험한 당뇨병 환자의 치료지시 불이행, 가족지지가 우울에 미치는 영향 (Influence of Non-compliance of Treatment and Family Support on Depression in Diabetic Patients with Hypoglycemia)

  • 손혜경;정경숙
    • 한국콘텐츠학회논문지
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    • 제18권6호
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    • pp.518-528
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    • 2018
  • 본 연구는 저혈당을 경험한 당뇨병 환자의 우울에 미치는 영향요인을 파악하여 대상자의 우울을 감소시키기 위한 기초자료를 마련하고자 2015년 10월 1일부터 2016년 3월 15일까지 B광역시 소재 일 병원의 내분비내과 외래를 방문한 119명을 대상으로 설문지를 배부하여 자료를 수집하였다. 수집된 자료는 SPSS 20.0 프로그램을 이용하여 빈도와 백분율, t-검증, 일원분산분석, 사후검증(Scheffe's-test), Pearson's correlation, 단계적 다중회귀분석을 실시하였다. 본 연구 결과 대상자의 우울은 치료지시불이행(r=.42, p<.001)과는 양의 상관관계를, 가족지지(r=-.38, p<.001)와는 음의 상관관계를 보였다. 대상자의 우울에 영향을 미치는 요인은 가족지지(${\beta}=-.29$, p<.001), 치료지시불이행의 하위영역인 약물요법(${\beta}=.21$, p=.020), 식이요법(${\beta}=.23$, p=.014), 한 달 평균 수입 300만원 이상(${\beta}=-.20$, p=.014), 한 달 평균 수입 200만원 이상-300만원 미만(${\beta}=-.17$, p=.033)으로 확인되었으며, 총 30.0%를 설명하였다(Adj. R2=.30, F=20.06, p<.001). 이를 바탕으로 대상자의 우울을 감소시키기 위하여 가족지지 향상 프로그램을 개발하여 적용할 것을 제안한다.

후기 덤핑증후군으로 유발된 저혈당성 경련발작 (Hypoglycemic Convulsive Seizure Due to Late Dumping Syndrome)

  • 정규온;문혜진
    • 대한신경과학회지
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    • 제36권4호
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    • pp.363-365
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    • 2018
  • Dumping syndrome is a common complication of esophageal or gastric surgery. Patients with late dumping syndrome usually suffer from hypoglycemic symptoms such as palpitation, tremor, and general weakness. Hypoglycemia induced convulsive seizure due to late dumping syndrome is rarely reported. We report a 46-year-old man with postprandial hypoglycemic convulsive seizure as the first symptom of late dumping syndrome.

고용량 Insulin lispro 피하 주사 후 저 인슐린 혈증을 보인 지속적 저혈당성 혼수 환자 1례 (Low Plasma Insulin Level Prolonged Hypoglycemia after High dose Insulin Lispro Injection)

  • 강정호;박현수
    • 대한임상독성학회지
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    • 제14권2호
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    • pp.151-154
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    • 2016
  • Increased plasma insulin levels are often observed in exogenous insulin overdose patients. However, plasma insulin level may decrease with time. We report a case of low plasma insulin level hypoglycemia after insulin lispro overdose. The patient was a 37-year-old man with no previous medical history who suspected insulin lispro overdose. Upon arrival, his Glasgow coma scale was 3 points and his blood sugar level (BSL) was 24 mg/dl. We found five humalog-quick-pen (insulin lispro) in his bag. There was no elevation of glucose level, despite an initial 50 ml bolus of 50% glucose and 150 cc/hr of 10% dextrose continuous intravenous infusion. He also suffered from generalized tonic-clonic seizure, which was treated with lorazepam and phenytoin. We conducted endotracheal intubation, after which he was admitted to the intensive care unit (ICU). There were recurrent events of hypoglycemia below BSL<50 mg/dl after admission. We repeatedly infused 50 ml 50% glucose 10 times and administered 1 mg of glucagon two times. The plasma insulin level was 0.2 uU/ml on initial blood sampling and 0.2 uU/ml after 5 hours. After 13 hours, his BSL stabilized but his mental status had not recovered. Diffuse brain injury was observed upon magnetic resonance imaging (MRI) and severe diffuse cerebral dysfunction was found on electroencephalography (EEG). Despite 35 days of ICU care, he died from ventilator associated pneumonia.