Fang LZ, Jin HX, Zhao N, Wu YP, Shi YQ. Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports. World J Clin Cases 2024; 12(1): 157-162 [PMID: 38292637 DOI: 10.12998/wjcc.v12.i1.157]
Corresponding Author of This Article
Ling-Zhi Fang, MSc, Pharmacist, Department of Pharmacy, Hebei Key Laboratory of Clinical Pharmacy, Hebei General Hospital, No. 348 Heping West Road, Xinhua District, Shijiazhuang 050051, Hebei Province, China. fanglingzhi99@163.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 6, 2024; 12(1): 157-162 Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.157
Successful management of severe hypoglycemia induced by total parenteral nutrition in patients with hepatocellular injury: Three cases reports
Ling-Zhi Fang, Hui-Xin Jin, Na Zhao, Yu-Pei Wu, Ying-Qin Shi
Ling-Zhi Fang, Hui-Xin Jin, Na Zhao, Yu-Pei Wu, Ying-Qin Shi, Department of Pharmacy, Hebei Key Laboratory of Clinical Pharmacy, Hebei General Hospital, Shijiazhuang 050051, Hebei Province, China
Author contributions: Fang LZ and Shi YQ contributed to the conception and design of the research; Jin HX and Zhao N contributed to analysis of the data; Wu YP contributed to manuscript preparation; All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ling-Zhi Fang, MSc, Pharmacist, Department of Pharmacy, Hebei Key Laboratory of Clinical Pharmacy, Hebei General Hospital, No. 348 Heping West Road, Xinhua District, Shijiazhuang 050051, Hebei Province, China. fanglingzhi99@163.com
Received: September 7, 2023 Peer-review started: September 7, 2023 First decision: November 1, 2023 Revised: November 7, 2023 Accepted: December 19, 2023 Article in press: December 19, 2023 Published online: January 6, 2024 Processing time: 116 Days and 23.6 Hours
Abstract
BACKGROUND
Glucose imbalance is common in total parenteral nutrition (TPN). Hypoglycemia seems to be less frequent than hyperglycemia, but it influences the clinical outcome to a greater extent. Therefore, it should be effectively prevented and treated. However, there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury.
CASE SUMMARY
We present three patients with liver cell injury who developed severe hypoglycemia during or after TPN infusion. The causes of severe hypoglycemia and glucose-raising strategies were discussed. According to the physiological characteristics of the hepatocellular injury, the ratio of nutrition components prescribed in TPN was appropriately adjusted for the three cases. We simultaneously reduced the dose of insulin and fat emulsion, and increased the dose of glucose in TPN. The blood glucose level was restored to normal range and clinical symptoms were eliminated.
CONCLUSION
When hypoglycemia occurs during or after TPN in patients with hepatocellular injury, physicians need to simultaneously reduce insulin and fat emulsion, and increase glucose, and correct severe hypoglycemia in time to reduce its adverse consequences.
Core Tip: Glucose imbalance is common in total parenteral nutrition (TPN). Hypoglycemia seems to be less frequent than hyperglycemia, but it influences the clinical outcome to a greater extent. Therefore, it should be prevented and treated. At present, there is no relevant report on how to treat hypoglycemia caused by TPN in patients with liver cell injury. We reported that three patients with liver cell injury developed severe hypoglycemia during or after TPN. The causes of severe hypoglycemia and the strategy of increasing glucose were discussed, which can provide a reference for reducing the adverse consequences of hypoglycemia.
