食後急峻高血糖
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出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2014/10/06 22:14:30」(JST)
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Oxyhyperglycemia is a special type of Impaired glucose tolerance characterized by a rapid and transient hyperglycemia (ie rise in blood glucose) spike after an oral intake of glucose, the peak of this spike being high enough to cause transient, symptom free glycosuria (i.e. detectable glucose in urine), but this hyperglycemia reverses rapidly and may even go to hypoglycemia in the later phase. This sharp downstroke overshooting towards hypoglycemia distinguishes this pathologic phenomenon from the artificial hyperglycemia inducible by an intravenous bolus dose of a large amount of glucose solution. Early dumping syndrome patients usually have oxyhyperglycemia associated with any meal or OGTT.
The Greek root oxy means "sharp" or "pointy".[1][2] The OGTT curve in this condition appears sharp and somewhat pointy (at least relative to the other forms of hyperglycemia)- hence this name.
Dorlands dictionary defines oxyhyperglycemia as:[3]
- "A condition in which there is slight glycosuria and an Oral Glucose Tolerance curve that rises about 180-200 mg/dL but returns to fasting value 2.5 hrs after ingestion of the glucose."
A blood level of approximately 180 mg/dL is the renal glucose threshold below which all glucose is reabsorbed from glomerular filtrate. But at blood concentrations above the renal threshold sugar starts appearing in the urine.
Oxyhyperglycemia, like other forms of Impaired glucose tolerance has also been suggested to be a prediabetic condition[4]
Contents
- 1 Usual cause
- 2 Distinction from regular impaired glucose tolerance
- 3 Mechanism
- 4 See also
- 5 References
Usual cause
Oxyhyperglycemia is most commonly caused by early dumping syndrome, but it can rarely caused by other conditions like Graves' disease.[5] It was first described by Lawrence et al in 1936[6][7] as often happening after gastroenterostomy. It is seen in most forms of gastrectomy, gastric bypass and gastrostomy procedures, all of which are surgical causes of dumping syndrome.
Distinction from regular impaired glucose tolerance
Most patients (or animals) with prediabetic type impaired glucose tolerance (serum glucose 140–200 mg/dL at 2 hours after OGTT) are generally not oxyhyperglycemic because:
- Glycosuria is not necessary for mild impaired glucose tolerance (e.g. at approx 140–180 mg/dL range of blood glucose), is necessary for oxyhyperglycemia (i.e. peak >renal threshold).
- In contrast to the commonly seen shallow OGTT curve, amplitude of the pointy spike in oxyhyperglycemia need not necessarily be restricted to only prediabetic range and in severe oxyhyperglycemia it may cross 250 mg/dL. In oxyhyperglycemia, by two hours, the glucose not only comes back to pre-diabetic range it may even start shooting below the fasting baseline.
- In oxyhyperglycemia, both the upstroke (by 30 minutes) and down stroke (by 2.5 hr) happens quite fast which is unusual for other forms of prediabetes. In most cases of impaired tolerance, glucose levels usually do not come down as quickly, rather lasts for 2 hours or more. Whereas if the oxyhyperglycemia is due to an early dumping syndrome it may be followed by a late dumping syndrome which may even have a hypoglycemic state. For animal studies, occasionally oxyhyperglycemia is written as synonymous for impaired glucose tolerance[8] but mostly in the right context of gastrectomy, thus actually implying its narrower meaning than impaired glucose tolerance.
Mechanism
In early dumping syndrome, pancreatic glucagon is augmented in the early postprandial period, probably through stimulation the catecholamines involved in the generalized autonomic surge induced by the osmotic load, but at 120 min, when most of the hypoglycemias are encountered, pancreatic glucagon is no longer detectable, likely through inhibition by GLP-1.[9][10] Incretins including GLP1 and GIP also bring in the late dumping effects including the insulin rise and the reactive hypoglycemia.[11]
See also
Impaired glucose tolerance
References
- ^ http://wordquests.info/cgi/ice2-for.cgi?file=/hsphere/local/home/scribejo/wordquests.info/htm/L-Gk-oxy-O-P.htm&HIGHLIGHT=oxy
- ^ List of Greek and Latin roots in English
- ^ Dorland's Illustrated Medical Dictionary E-Book Elsevier Health Sciences, 2 May 2011 - 2176 pages http://books.google.co.in/books?id=mNACisYwbZoC&pg=PT6008&lpg=PT6008&dq=oxyhyperglycemia+glycosuria&source=bl&ots=aX7RNVcZk0&sig=kPMLuW1Ftdeiiz3WPuSGAT90U1w&hl=en&sa=X&ei=qeKWT7bdBcHlrAeQn5yDDg&ved=0CGEQ6AEwCA#v=onepage&q=oxyhyperglycemia%20glycosuria&f=false
- ^ Takayoski Tobe; Mamoru Kouchi; Hiroshi Tanimura; Chiu Hsiung Huang Hyperglycemia After Gastrectomy as a Prediabetic State: Clinical Study of 100 Postgastrectomy Patients AMA Arch Surg. 1967;94(6):836-840. http://archsurg.ama-assn.org/cgi/content/summary/94/6/836
- ^ Nagoya J Med Sci. 1994 Mar;57(1-4):61-8. Glucose and insulin metabolism in patients with hyperthyroidism due to Graves' disease. Mano T, Kawakubo A, Yamamoto M. http://www.med.nagoya-u.ac.jp/medlib/nagoya_j_med_sci/5712/v57n12p61_68.pdf
- ^ Lawrence, R.D.: Symptomless Glycosurias: Differentiation by Sugar Tolerance Tests , Med Clin N Amer 31:289, 1947
- ^ Tobe T, Kouchi M, Tanimura H, Huang C. Hyperglycemia after gastrectomy as a prediabetic stateclinical study of 100 postgastrectomy patients. Arch Surg. 1967;94(6):836-840.
- ^ Journal of Endocrinology (1999) 160, 285–289 http://joe.endocrinology-journals.org/content/160/2/285.full.pdf
- ^ Digestive Diseases and Sciences Volume 46, Number 9 (2001), 1915-1923, DOI: 10.1023/A:1010635131228 Postprandial GLP-1, Norepinephrine, and Reactive Hypoglycemia in Dumping Syndrome. B. Gebhard, J.J. Holst, C. Biegelmayer and J. Miholic. http://www.springerlink.com/content/r4626264524qt827/
- ^ Digestive Diseases and Sciences Volume 50, Number 12 (2005), 2263-2267, DOI: 10.1007/s10620-005-3046-2. A Possible Role of GLP-1 in the Pathophysiology of Early Dumping Syndrome. Hiroshi Yamamoto, Tsuyoshi Mori, Hiroshi Tsuchihashi, Hiroya Akabori, Hiroyuki Naito and Tohru Tani. http://www.springerlink.com/content/p411j56584772038/
- ^ The Journal of Clinical Endocrinology & Metabolism December 1, 2007 vol. 92 no. 12 4678-4685 Patients with Neuroglycopenia after Gastric Bypass Surgery Have Exaggerated Incretin and Insulin Secretory Responses to a Mixed Meal. A. B. Goldfine, E. C. Mun, E. Devine, R. Bernier, M. Baz-Hecht, D. B. Jones, B. E. Schneider, J. J. Holst and M. E. Patti. http://jcem.endojournals.org/content/92/12/4678.full
Abnormal clinical and laboratory findings for blood tests (R70–R79, 790)
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Red blood cells |
Size
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- Anisocytosis
- Macrocyte
- Microcyte
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Shape
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- membrane abnormalities: Acanthocyte
- Codocyte
- Ovalocyte
- Spherocyte
- other: Dacrocyte
- Echinocyte
- Schistocyte
- Degmacyte
- Drepanocyte
- Stomatocyte
- Knizocyte
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Hemoglobinization
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Inclusion bodies
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- developmental organelles (Howell-Jolly body, Basophilic stippling, Pappenheimer bodies, Cabot rings)
- abnormal hemoglobin precipitation (Heinz body)
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Other
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- Rouleaux
- Reticulocyte
- Elevated ESR
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Lymphocytes |
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Small molecules |
Blood sugar
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- Hypoglycemia
- Hyperglycemia
- Prediabetes (Impaired fasting glucose, Impaired glucose tolerance)
- Oxyhyperglycemia
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Nitrogenous
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- Azotemia
- Hyperuricemia
- Hypouricemia
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Proteins |
LFT
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- Elevated transaminases
- Elevated ALP
- Hypoproteinemia (Hypoalbuminemia)
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Other
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- Elevated cardiac markers
- Elevated alpha-fetoprotein
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Minerals |
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Pathogens/sepsis |
- Bacteremia
- Viremia
- Fungemia
- Parasitemia
- Algaemia
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cell/phys (coag, heme, immu, gran), csfs
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rbmg/mogr/tumr/hist, sysi/epon, btst
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drug (B1/2/3+5+6), btst, trns
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noco/acba/cong/tumr, sysi/epon, urte
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proc/itvp, drug (G4B), blte, urte
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Japanese Journal
- 反応性低血糖の臨床的意義 (特集 低血糖患者の診療)
- 塩澤 邦久,北川 裕久,中村 慶史,西村 元一,藤村 隆,萱原 正都,清水 康一,太田 哲生,三輪 晃一,野々村 昭孝
- 日本消化器外科学会雑誌 35(12), 1788-1792, 2002-11-25
- 49歳の男性.1990年検診で高血糖を指摘されていた.2000年4月頃より体重減少(5kg/6か月)を認め,近医受診したところ膵腫瘍を指摘され当科入院となった.入院時,耐糖能障害,血中グルカゴン高値を認め,CT検査にて膵体尾部に複数個の腫瘍を,血管造影では同部位に腫瘍濃染像を認めた.以上より,グルカゴノーマを疑い膵体尾部切除を行った.腫瘍は膵体尾部に3個((1)〜(3))存在した.病理所見では,腫 …
- NAID 110001292616
- 経口糖負荷試験にみられる oxyhyperglycemia - 胃切除者60名における検討 -
- 加地 浩,森田 恵美子,池田 正人,日野 義之,筒井 隆夫,紙谷 尚子
- 糖尿病 44(7), 549-554, 2001-07-30
- NAID 10006818947
Related Links
- ぴょこぴょこ メモ 自分のための備忘録・・・ なので、間違った記述があっても責任は取れないです。ご了承下さい(。 ... 3nyoroさんの庭を見に行く oxyhyperglycemia 急峻高血糖症 →Basedow病の患者で、約30~50%にみられる耐糖能異常の ...
- その30~50%に耐糖能の異常を伴う.この異常はOxyhyperglycemiaといわれる.ブドウ糖の腸管吸収促進と糖代謝亢進により初期の血糖上昇が著しく(oxyとは“鋭い,急峻”という意味),以後 ...
Related Pictures
★リンクテーブル★
[★]
- 英
- hyperglycemia, hyperglycaemia
- 同
- 過血糖症、高血糖症
- 関
- 糖尿病。低血糖。糖負荷試験
鑑別疾患
- 脳神経障害、心肺停止、ショックなどで血糖が高いほど脳損傷が強く出現する (研修医当直御法度 症例帳 p.4)
治療
- HHSでもDKAでもないが、内服コンプライアンス不良例における、随時血糖500-700mg/dL程度の患者に対するひとまずの治療
- ひとまず見逃してはいけない疾患を除外する:基本的には上記「鑑別疾患」を除外
- 0.9% 生理食塩水 + ヒューマリンR。時間100ml/hrで滴下。
- 1時間毎にデキストロ測定する。
[★]
- 英
- oxyhyperglycemia
- 同
- 急峻高血糖
- 関
- 高血糖