低血糖を契機に低体温から極度の徐脈を繰り返し起こした1型糖尿病の1症例 A Patient with Type 1 Diabetes in Whom Hypoglycemia-related Hypothermia Repeatedly Induced Marked Bradycardia

この論文にアクセスする

この論文をさがす

著者

    • 大谷 敏嘉 Otani Toshika
    • さいたま記念病院内科|東京女子医科大学糖尿病センター Department of Internal Medicine, Saitama Memorial Hospital|Diabetes Center, Tokyo Women's Medical University School of Medicine
    • 青木 厚 Aoki Atsushi
    • 自治医科大学附属さいたま医療センター内分泌代謝科 Department of Endocrinology and Metabolism, Saitama Medical Center, Jichi Medical University
    • 生駒 亜希 Ikoma Aki
    • 自治医科大学附属さいたま医療センター内分泌代謝科 Department of Endocrinology and Metabolism, Saitama Medical Center, Jichi Medical University

抄録

症例は67歳男性.42歳時に糖尿病を診断され,インスリン療法が開始されるも高血糖状態が持続していた.2012年2月7日冷汗を伴う低血糖を契機として低体温から失見当識障害を起こし2月10日初回入院となった.体温測定不能(32.0 ℃未満),心拍数35/分,血糖値90 mg/d<i>l</i>.心電図では徐脈,J波(V4-6)を認めた.復温処置,ブドウ糖の静脈注射,補液により翌朝には体温36 ℃,心拍数60台/分に回復し,心電図上J波は消失した.同年3月5日意識障害のため搬送入院となった.体温30.8 ℃,心拍数23/分,血糖65 mg/d<i>l</i>.復温処置による体温上昇とともに意識は回復し正常洞調律に復帰した.同年4月11日夕食直後に意識障害が出現し搬送入院となった.体温32.8 ℃,心拍数26/分.R-R間隔変動係数0.90 %.重症自律神経障害のため低血糖を契機に低体温から極度の徐脈を繰り返し起こした症例と考えた.

The patient was a 67-year-old male. At 42 years of age, diabetes was diagnosed. Insulin therapy was started; however, the hyperglycemia persisted. On February 7, 2012, hypoglycemia with cold sweating led to hypothermia, causing disorientation. On February 10, the patient was admitted. It was impossible to measure his body temperature (BT) (lower than 32.0 °C). His heart rate (HR) was 35/min and his blood glucose level (BG) was 90 mg/d<i>l</i>. Electrocardiography showed bradycardia and J waves (V4-6). The administration of BT recovery treatment, intravenous glucose injection and fluid replacement increased the BT and HR to 36.0 °C and 60/min or more, respectively, the following morning. Electrocardiography confirmed the disappearance of J waves. On March 5, the patient was admitted with a consciousness disorder. The BT, HR, and BG were 30.8 °C, 23/min, and 65 mg/d<i>l</i>, respectively. The treatment-related rise in BT was observed, consciousness was regained, and a normal sinus rhythm a returned. On April 11, a consciousness disorder appeared immediately after dinner, and the patient was therefore admitted to our hospital. The BT and HR were 32.8 °C and 26/min, respectively. The coefficient of variation R-R interval was 0.90 %. Due to severe autonomic neuropathy, hypothermia-related hypothermia may have repeatedly induced marked bradycardia.

収録刊行物

  • 糖尿病

    糖尿病 57(2), 124-130, 2014

    一般社団法人 日本糖尿病学会

各種コード

  • NII論文ID(NAID)
    130004511384
  • NII書誌ID(NCID)
    AN00166576
  • 本文言語コード
    JPN
  • ISSN
    0021-437X
  • NDL 記事登録ID
    025311425
  • NDL 請求記号
    Z19-401
  • データ提供元
    NDL  J-STAGE 
ページトップへ