Causes of hyperglycemia and hypoglycemia in adult inpatients.
Causes of hyperglycemia and hypoglycemia in adult inpatients.
复制标题
成人住院患者高血糖和低血糖的原因。
DOI：
--
复制
发表时间：
2005
影响因子：
2.7
通讯作者：
B. Sauer
中科院分区：
文献类型：
--
作者：
Wendy D. Smith;A. Winterstein;T. Johns;E. Rosenberg;B. Sauer
目的
本文探讨了成人内科和外科住院病人高血糖和低血糖的潜在原因。
方法
从医院实验室生成的血糖水平异常的自动每日打印中，前瞻性地确定了2003年2月至7月期间在三级护理医院住院的成人内科和外科患者中发生的高血糖和低血糖事件。通过图表审查以及提供者和患者访谈，在24小时内确定了关于随机抽样事件原因的信息。将叙述提交给专家委员会，以评估每起事件的原因和可预防性。
结果
24例低血糖事件中的18例和26例高血糖事件中的26例被认为是可预防的。未能调整降糖药物以应对口服摄入量减少和意外偏离正常的医院常规是导致低血糖的最常见因素。高血压通常与供应商不愿意承担糖尿病管理的责任和独家使用滑动标度胰岛素方案有关。
结论
内科和外科住院患者的高血糖和低血糖大多与处方、监测和沟通实践不足有关。
PURPOSE
The underlying causes of hyperglycemia and hypoglycemia in adult medical and surgical inpatients were studied.
METHODS
Hyperglycemic and hypoglycemic events occurring in adult medical and surgical patients admitted between February and July 2003 to a tertiary care hospital were identified prospectively from automated daily printouts of abnormal blood glucose levels generated by the hospital laboratory. Information on the causes of a random sample of events was ascertained within 24 hours through chart review and provider and patient interviews. Narratives were presented to an expert committee to assess the causes of each event and preventability.
RESULTS
Eighteen of 24 hypoglycemic events and 26 of 26 hyperglycemic episodes were considered preventable. Failure to adjust antidiabetic drugs in response to decreases in oral intake and unexpected deviation from normal hospital routine were the most common factors contributing to hypoglycemia. Hyperglycemia was most often associated with an unwillingness of providers to take responsibility for diabetes management and the exclusive use of sliding-scale insulin regimens.
CONCLUSION
Hyperglycemia and hypoglycemia in medical and surgical inpatients were mostly related to inadequate prescribing, monitoring, and communication practices.