{"id":1106,"date":"2016-12-11T17:12:36","date_gmt":"2016-12-11T16:12:36","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/11\/hypoglykemie\/"},"modified":"2017-10-03T14:34:19","modified_gmt":"2017-10-03T12:34:19","slug":"hypoglycemias","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/hypoglycemias\/","title":{"rendered":"Hypoglycemias"},"content":{"rendered":"<pre><span style=\"color: #ff0000;\"><strong>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper. <\/strong><\/span><\/pre>\n<p>&nbsp;<\/p>\n<p><strong>Klinick\u00fd v\u00fdznam a defin\u00edcia<br \/>\n<\/strong><br \/>\nKlinicky z\u00e1va\u017en\u00e1 hypoglyk\u00e9mia je stav, ktor\u00fd vedie k poruche mozgov\u00fdch funkci\u00ed v d\u00f4sledku neuroglykop\u00e9nie, protrahovan\u00e1 nelie\u010den\u00e1 hypoglyk\u00e9mia sa kon\u010d\u00ed k\u00f3mou a smr\u0165ou. Najm\u00e4 v \u010dase intenz\u00edvneho v\u00fdvoja mozgu, v novorodeneckom obdob\u00ed \u010di v ranom detstve m\u00f4\u017eu ma\u0165 opakovan\u00e9 epiz\u00f3dy<br \/>\nz\u00e1va\u017en\u00fdch hypoglyk\u00e9mi\u00ed za n\u00e1sledok trval\u00e9 neurologick\u00e9 po\u0161kodenie.<br \/>\nHypoglyk\u00e9mia sa laborat\u00f3rne definuje ako pokles glyk\u00e9mie pod doln\u00fa hranicu normy ur\u010denej pre dan\u00fd vek, biologick\u00fd materi\u00e1l a pou\u017eit\u00fa met\u00f3du. Z klinick\u00e9ho h\u013eadiska sa hypoglyk\u00e9mia definuje ako pokles pod doln\u00fa hranicu norm\u00e1lnych hodn\u00f4t, ktor\u00e9 zaru\u010duj\u00fa zachovanie norm\u00e1lnych mozgov\u00fdch funkci\u00ed. Na praktick\u00e9<br \/>\n\u00fa\u010dely sa za hypoglyk\u00e9miu pova\u017euj\u00fa hodnoty vo ven\u00f3znej plazme nala\u010dno pre\u00a0v\u0161etky vekov\u00e9 kateg\u00f3rie (novorodenci od 4. d\u0148a \u017eivota) 2,8 mmol\/l a menej (3). Typick\u00e9 klinick\u00e9 prejavy hypoglyk\u00e9mie b\u00fdvaj\u00fa adrenergick\u00e9 \u2013 tras,\u00a0nervozita, tachykardia, zv\u00fd\u0161en\u00e9 potenie, bledos\u0165, hlad, nauzea a vracanie,\u00a0ako aj neuroglykopenick\u00e9 \u2013 bolesti hlavy, poruchy koncentr\u00e1cie, zmeny\u00a0v spr\u00e1van\u00ed, r\u00f4zne poruchy videnia, dysartria, k\u0155\u010de, ataxia, hemipl\u00e9gia, af\u00e1zia,\u00a0somnolencia \u010di ob\u00e1van\u00e1 k\u00f3ma. Kritick\u00e1 hypoglyk\u00e9mia m\u00f4\u017ee by\u0165 individu\u00e1lne\u00a0odli\u0161n\u00e1, opakovan\u00fdm protrahovan\u00fdm hladovan\u00edm sa vyv\u00edja adapt\u00e1cia\u00a0a k rozvoju pr\u00edznakov ned\u00f4jde ani pri ni\u017e\u0161\u00edch glyk\u00e9mi\u00e1ch. Naopak,\u00a0u diabetikov m\u00f4\u017ee by\u0165 pr\u00edtomn\u00e1 neuroglykopenick\u00e1 symptomatol\u00f3gia\u00a0pri glyk\u00e9mi\u00e1ch, ktor\u00e9 s\u00fa u zdrav\u00fdch e\u0161te dobre tolerovan\u00e9.<br \/>\nAko \u201epseudohypoglyk\u00e9miu\u201c ozna\u010dujeme laborat\u00f3rne potvrden\u00fa\u00a0hypoglyk\u00e9miu bez klinick\u00fdch pr\u00edznakov, ktor\u00e1 je d\u00f4sledkom zv\u00fd\u0161enej\u00a0utiliz\u00e1cie gluk\u00f3zy formovan\u00fdmi elementmi krvi v sk\u00famavke po odbere<br \/>\nkrvi (leukocyt\u00f3za, trombocyt\u00f3za, erytrocyt\u00f3za).<br \/>\nNa klinick\u00fa diagnostiku v\u00fdznamnej symptomatickej hypoglyk\u00e9mie sa\u00a0pou\u017e\u00edva tzv. Whippleho tri\u00e1da:<br \/>\n1. pr\u00edtomnos\u0165 typick\u00fdch klinick\u00fdch pr\u00edznakov hypoglyk\u00e9mie<br \/>\n2. n\u00edzka koncentr\u00e1cia plazmatickej gluk\u00f3zy<br \/>\n3. vymiznutie prejavov hypoglyk\u00e9mie po podan\u00ed gluk\u00f3zy<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Kl<\/strong><strong>a<\/strong><strong>s<\/strong><strong>i<\/strong><strong>fik\u00e1cia<br \/>\n<\/strong><\/p>\n<p>Etiopatogn\u00e9za \u00a0hypoglykemick\u00fdch \u00a0stavov je ve\u013emi r\u00f4znorod\u00e1. Deli\u0165 tieto stavy mo\u017eno \u00a0pod\u013ea rozli\u010dn\u00fdch h\u013ead\u00edsk, pri\u010dom\u00a0 nie v\u0161etky stavy mo\u017e-no zadeli\u0165 do jednej alebo druhej skupiny, napr\u00edklad hypoglyk\u00e9mie \u00a0pri inzulin\u00f3me s\u00fa charakteristick\u00e9 v\u00fdskytom nala\u010dno aj po jedle (tabu\u013eka 1).<\/p>\n<p>Hypoglyk\u00e9mie nala\u010dno tvoria ve\u013ek\u00fa skupinu \u00a0stavov, ktor\u00e9 vznikaj\u00fa v d\u00f4sledku zn\u00ed\u017eenej produkcie gluk\u00f3zy alebo jej zv\u00fd\u0161enej utiliz\u00e1cie (tabu\u013eka 2).<\/p>\n<p>Hypoglyk\u00e9mie postprandi\u00e1lne \u2013 pod\u013ea \u010dasov\u00e9ho intervalu od pr\u00edjmu potravy je mo\u017en\u00e9 ich rozdeli\u0165 na v\u010dasn\u00e9, vznikaj\u00face 2 \u2013 3 hodiny po jedle a neskor\u00e9 vznikaj\u00face 3 \u2013 5 hod\u00edn po jedle. Pr\u00ed\u010dinou je zv\u00fd\u0161en\u00e1 sekr\u00e9cia inzul\u00ednu s n\u00e1slednou zv\u00fd\u0161enou utiliz\u00e1ciou gluk\u00f3zy (tabu\u013eka 3).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>a<\/strong><strong>b<\/strong><strong>o<\/strong><strong>ra<\/strong><strong>t\u00f3<\/strong><strong>r<\/strong><strong>n<\/strong><strong>a diagnostika<\/strong><\/p>\n<p>Prakticky mo\u017eno hypoglyk\u00e9mie rozdeli\u0165 na hyperinzul\u00ednov\u00e9 a hypoinzul\u00ednov\u00e9. Pr\u00ed\u010dinou hyperinzul\u00ednov\u00fdch hypoglyk\u00e9mi\u00ed je naj\u010dastej\u0161ie nadprodukcia\u00a0endog\u00e9nneho inzul\u00ednuu dospel\u00fdch inzulin\u00f3m\/nezidioblast\u00f3za, kongenit\u00e1lny hyperinzulinizmus u det\u00ed. N\u00e1ro\u010dn\u00e9 \u00a0m\u00f4\u017ee \u00a0by\u0165 odl\u00ed\u0161i\u0165 endog\u00e9nny \u00a0hyperinzulinizmus od exog\u00e9nneho pri <em>h<\/em><em>y<\/em><em>po<\/em><em>g<\/em><em>l<\/em><em>yc<\/em><em>a<\/em><em>emi<\/em><em>a factitia <\/em>\u2013 zneu\u017e\u00edvanie inzul\u00ednov\u00fdch pr\u00edpravkov\/deriv\u00e1tov sulfonylurey v r\u00e1mci chorobn\u00e9ho \u00a0sebapo\u0161kodzovania (1).<\/p>\n<p>Pri hypoinzul\u00ednov\u00fdch \u00a0hypoglykemick\u00fdch \u00a0stavoch zlyh\u00e1va bu\u010f kontraregul\u00e1cia \u2013 p\u00e1tra\u0165 po endokrinopatii, alebo je pr\u00ed\u010dina metabolick\u00e1 \u2013 predov\u0161etk\u00fdm v detskom veku p\u00e1tra\u0165 po dedi\u010dnej metabolickej poruche (DPM) (2). Diagnostick\u00fd postup pre dospel\u00fdch pacientov bez DM je uveden\u00fd v tabu\u013eke 4.<\/p>\n<p>Zlat\u00fd \u0161tandard v diferenci\u00e1lnej diagnostike hypoglyk\u00e9mi\u00ed zost\u00e1va tzv. hladov\u00fd test, odpor\u00fa\u010dan\u00fd protokol (tabu\u013eka 5), diagnostick\u00e1\u00a0 interpret\u00e1cia v\u00fdsledkov hladov\u00e9ho testu \u2013 tabu\u013eka 6. O endog\u00e9nnom hyperinzulinizme sved\u010d\u00ed v\u00fdskyt pr\u00edznakov pri plazmatickej \u00a0glyk\u00e9mii menej \u00a0ako 3,0 mmol\/l a s\u00fa\u010dasne koncentr\u00e1cii inzul\u00ednu aspo\u0148 3,0 mIU\/l, C-peptidu \u00a0aspo\u0148 0,6 ug\/l (0,2 nmol\/l) a proinzul\u00ednu aspo\u0148 5,0 pmol\/l. Koncentr\u00e1cia \u03b2-hydroxybuty- r\u00e1tu 2,7 mmol\/l \u00a0alebo menej \u00a0a n\u00e1rast plazmatickej glyk\u00e9mie aspo\u0148 o 1,4 mmol\/l po i. v. podan\u00ed \u00a0glukag\u00f3nu \u00a0sved\u010d\u00ed o \u00fa\u010dinku inzul\u00ednu alebo IGF.<\/p>\n<p>U pacientov s anamn\u00e9zou \u00a0postprandi\u00e1lnej hypoglyk\u00e9mie mo\u017eno vykona\u0165 tzv. mixedmeal \u00a0test (tabu\u013eka 7). OGT T a v minulosti pou\u017e\u00edvan\u00e9 stimula\u010dn\u00e9 a supres\u00edvne testy dnes v diferenci\u00e1lnej diagnostike hypoglyk\u00e9mi\u00ed u\u017e nemaj\u00fa v\u00fdznam.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>H<\/strong><strong>ypog<\/strong><strong>l<\/strong><strong>y<\/strong><strong>k<\/strong><strong>\u00e9<\/strong><strong>m<\/strong><strong>i<\/strong><strong>e v detskom veku<\/strong><\/p>\n<p>Prechodn\u00e9 hypoglyk\u00e9mie u novorodencov s\u00fa \u010dast\u00e9 (podmienen\u00e9 po- p\u00f4rodnou adapt\u00e1ciou), ale, naopak, za prolongovanou hypoglyk\u00e9miou sa m\u00f4\u017eu ukr\u00fdva\u0165 aj z\u00e1va\u017en\u00e9 ochorenia \u00a0(3). Hodnoty \u00a0glyk\u00e9mie kr\u00e1tko po naroden\u00ed klesaj\u00fa a\u017e na hodnoty \u00a0okolo 1,7 mmol\/l \u00a0u donosen\u00fdch a 1,1 mmol\/l \u00a0u nedonosen\u00fdch novorodencov. Prolongovan\u00e1 hypoglyk\u00e9mia, ktor\u00e1 pretrv\u00e1va aj po p\u00e1r d\u0148och od p\u00f4rodu, vy\u017eaduje diferenci\u00e1lnu diagnostiku (tabu\u013eka 8).<\/p>\n<p>Medzi naj\u010dastej\u0161ie pr\u00ed\u010diny prolongovanej \u00a0hypoglyk\u00e9mie \u00a0u novorodencov patr\u00ed kongenit\u00e1lny hyperinzulinizmus a z metabolick\u00fdch pr\u00ed\u010din galaktoz\u00e9mia (4, 5). V doj\u010denskom obdob\u00ed a neskor\u0161om veku vznikaj\u00fa hypoglyk\u00e9mie \u00a0pri nadmernej \u00a0z\u00e1\u0165a\u017ei organizmu \u00a0spojenej so zn\u00ed\u017een\u00fdm pr\u00edjmom sacharidov, napr\u00edklad pri hladovan\u00ed, interkurentn\u00fdch infekci\u00e1ch, strese, zv\u00fd\u0161enej psychickej \u00a0z\u00e1\u0165a\u017ei alebo hor\u00fa\u010dke \u00a0(tzv. acetonemick\u00e9 vracanie). Tieto stavy m\u00f4\u017eu demaskova\u0165 dovtedy nepoznan\u00fa dedi\u010dn\u00fa metabolick\u00fa chorobu, ako je napr\u00edklad deficit MCAD (deficit acylkoenz\u00fdmu a\u00a0dehydrogen\u00e1zy mastn\u00fdch kysel\u00edn so stredne dlh\u00fdm re\u0165azcom, pomerne \u010dast\u00e1 dedi\u010dn\u00e1 metabolick\u00e1 porucha mitochondri\u00e1lneho metabolizmu \u03b2-oxid\u00e1cie mastn\u00fdch kysel\u00edn). Klinick\u00e9 pr\u00edznaky v novorodeneckom obdob\u00ed s\u00fa ne\u0161pecifick\u00e9 (hypot\u00f3nia, spavos\u0165, \u00a0slab\u00e9 pitie, apatia, zmeny pla\u010du, podr\u00e1\u017edenos\u0165, tremor, k\u0155\u010de, tachypnoe, \u00a0apnoe), \u00a0alebo sa pr\u00edznaky nemusia objavova\u0165 v\u00f4bec \u2013 tzv. asymptomatick\u00e1 hypoglyk\u00e9mia. Pri diagnostike hypoglyk\u00e9mie nemo\u017eno vych\u00e1dza\u0165 z Whippleho tri\u00e1dy. Preto \u00a0je d\u00f4le\u017eit\u00e9 opiera\u0165 \u00a0sa o laborat\u00f3rnu hodnotu glyk\u00e9mie, ktor\u00e1 je aj pre novorodencov od 4. d\u0148a \u017eivota posunut\u00e1 \u00a0na 2,8 mmol\/l, aby sa predch\u00e1dzalo trval\u00e9mu po\u0161kodeniu. V doj\u010denskom a neskor\u0161om veku s\u00fa klinick\u00e9 pr\u00edznaky \u0161pecifickej\u0161ie ako u novorodencov.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>a<\/strong><strong>b<\/strong><strong>o<\/strong><strong>ra<\/strong><strong>t\u00f3<\/strong><strong>r<\/strong><strong>n<\/strong><strong>e vy\u0161etrenie die\u0165a\u0165a s hypoglyk\u00e9miou<br \/>\n<\/strong><\/p>\n<p>Odber biologick\u00e9ho materi\u00e1lu \u2013 krvi a mo\u010du, je potrebn\u00e9 \u00a0vykona\u0165 po\u010das hypoglykemick\u00e9ho ataku pred za\u010dat\u00edm lie\u010dby (tabu\u013eka 9). Glyk\u00e9mia mus\u00ed by\u0165 verifikovan\u00e1 laborat\u00f3rne. Glukomerom nameran\u00e1 hodnota 3,3 mmol\/l a ni\u017e\u0161ia pri vyjadrenej symptomatol\u00f3gii u\u017e m\u00f4\u017ee by\u0165 v\u00fdznamn\u00e1, ke\u010f\u017ee glukomery m\u00f4\u017eu ma\u0165 a\u017e 20 % odch\u00fdlku od glyk\u00e9mie stanovenej\u00a0v laborat\u00f3riu (7). Vy\u0161etrenie na pr\u00edtomnos\u0165 ketol\u00e1tok v mo\u010di umo\u017en\u00ed rozdeli\u0165 hypoglyk\u00e9mie na hypo- alebo aketotick\u00e9 (najm\u00e4 pri hyperinzulinemick\u00fdch hypoglyk\u00e9mi\u00e1ch \u00a0a poruch\u00e1ch \u00a0tvorby ketol\u00e1tok) a ketotick\u00e9 s pr\u00edtomnos\u0165ou ketol\u00e1tok v mo\u010di (ostatn\u00e9 pr\u00ed\u010diny hypoglyk\u00e9mi\u00ed).<\/p>\n<p>&nbsp;<\/p>\n<p><strong>P<\/strong><strong>r<\/strong><strong>e<\/strong><strong>d<\/strong><strong>an<\/strong><strong>a<\/strong><strong>l<\/strong><strong>y<\/strong><strong>t<\/strong><strong>i<\/strong><strong>c<\/strong><strong>k<\/strong><strong>\u00e9 inform\u00e1cie<\/strong><\/p>\n<p>Vy\u0161etrenia realizovate\u013en\u00e9 v Medirex, a. s.:<\/p>\n<p>Gluk\u00f3za, kortizol, rastov\u00fd horm\u00f3n \u00a0(GH), IGF-1, TSH, f T4, z\u00e1kladn\u00e9 bio- chemick\u00e9 vy\u0161etrenia \u2013 odberov\u00e1 sk\u00famavka s g\u00e9lom, vy\u0161etrenie zo s\u00e9ra.<\/p>\n<p><em>P<\/em><em>o<\/em><em>zn\u00e1<\/em><em>m<\/em><em>ka<\/em><em>: \u00a0<\/em>Krv na vy\u0161etrenie glyk\u00e9mie v laborat\u00f3riu mus\u00ed by\u0165 odobrat\u00e1 do sk\u00famavky s pr\u00eddavkom inhib\u00edtora glykol\u00fdzy (NaF) \u2013 inak v nej koncent- r\u00e1cia gluk\u00f3zy artefici\u00e1lne kles\u00e1 cca 5 \u2013 7 % ka\u017ed\u00fa hodinu (8).<\/p>\n<p>C-peptid a inzul\u00edn \u2013 odber do sk\u00famavky s g\u00e9lom, doda\u0165 do laborat\u00f3ria \u010do najsk\u00f4r po odbere, po centrifug\u00e1cii transport na \u013eade, inak je potrebn\u00e9 vzorku zamrazi\u0165, vy\u0161etrenia s\u00fa zo s\u00e9ra.<\/p>\n<p>Amoniak \u2013 odberov\u00e1 sk\u00famavka s EDTA (ako na krvn\u00fd obraz), okam\u017eit\u00fd transport do laborat\u00f3ria na \u013eade, vy\u0161etrenie z plazmy.<\/p>\n<p>Lakt\u00e1t \u2013 odberov\u00e1 sk\u00famavka s NaF\/K-oxal\u00e1tom, doda\u0165 okam\u017eite do laborat\u00f3ria, scentrifugova\u0165 do 15 min\u00fat, vy\u0161etrenie z plazmy.<\/p>\n<p>3-hydroxybutyr\u00e1t \u00a0(realizuje sa iba v KE) \u2013 ako lakt\u00e1t.<\/p>\n<p><em>P<\/em><em>o<\/em><em>zn\u00e1<\/em><em>m<\/em><em>k<\/em><em>a<\/em><em>: \u00a0<\/em>Odberov\u00e9 n\u00e1dobky na lakt\u00e1t a 3-hydroxybutyr\u00e1t s\u00fa vhodn\u00e9 aj na vy\u0161etrenie plazmatickej glyk\u00e9mie.<\/p>\n<p>Vy\u0161etrenia v mo\u010di \u2013 vzorka rann\u00e9ho mo\u010du.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Z<\/strong><strong>\u00e1<\/strong><strong>ver<\/strong><\/p>\n<p>Hypoglyk\u00e9mie predstavuj\u00fa r\u00f4znorod\u00fa skupinu ochoren\u00ed. V ur\u010dit\u00fdch pr\u00edpadoch m\u00f4\u017eu sp\u00f4sobi\u0165 trval\u00e9 po\u0161kodenie CNS alebo a\u017e \u00famrtie. V\u010dasn\u00e1 diagnostika a lie\u010dba s\u00fa nevyhnutn\u00e9 \u00a0kdeko\u013evek, n\u00e1sledn\u00e1 komplexn\u00e1 diferenci\u00e1lna diagnostika sa realizuje na \u0161pecializovan\u00fdch pracovisk\u00e1ch.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>L<\/strong><strong>it<\/strong><strong>e<\/strong><strong>ra<\/strong><strong>t<\/strong><strong>\u00fa<\/strong><strong>ra<\/strong><\/p>\n<ol>\n<li>Mok\u00e1\u0148 M. Hypoglyk\u00e9mia. <em>V<\/em><em>nit\u0159L\u00e9k. <\/em>2008;54(4):387\u2013394.<\/li>\n<li>Laz\u00farov\u00e1 I, Payer \u00a0J, et al. <em>\u0160t<\/em><em>anda<\/em><em>r<\/em><em>dn<\/em><em>\u00e9 diagnostick\u00e9 <\/em><em>a terapeutick\u00e9 postupy v endokrinol\u00f3gii.\u00a0<\/em>Ko\u0161ice: Vienala; 2014.<\/li>\n<li>Ferenczov\u00e1 J, Podrack\u00e1 \u013d. Diferenci\u00e1lna diagnostika prolongovanej hypoglyk\u00e9mie u no- vorodencov a det\u00ed. <em>P<\/em><em>e<\/em><em>diatri<\/em><em>a pre prax. <\/em>2008;3:162\u2013165.<\/li>\n<li>Miller ER, Allen DB, Ferry RJ. <em>P<\/em><em>e<\/em><em>diatri<\/em><em>c Practice Endocrinology. <\/em>McGraw-Hill Education; 2014.<\/li>\n<li>Ranke MB, Mullis PE. <em>D<\/em><em>iagn<\/em><em>ostics <\/em><em>o<\/em><em>f Endocrine Function in Children and Adolescents<\/em>. S. Kar- ger AG; 2011.<\/li>\n<li>Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ. Evaluati- on and Managment of Adult Hypoglycemic \u00a0Disorders: An Endocrine Society Clinical Practi- ce Gudeline. <em>J Clin Endocrinol Metab. <\/em>2009;94(3):709\u2013728.<\/li>\n<li>Stan\u00edk J, Brennerov\u00e1 K, Roso\u013eankov\u00e1 M, Stan\u00edkov\u00e1 D, Tich\u00e1 \u013d, Ga\u0161per\u00edkov\u00e1 D, Klime\u0161 \u00a0I. Hypoglyk\u00e9mie u det\u00ed star\u0161\u00edch ako jeden rok. <em>P<\/em><em>e<\/em><em>diatri<\/em><em>a pre prax. <\/em>2015;16(1):11\u201313.<\/li>\n<li>Pr\u016f\u0161a R. <em>P<\/em><em>r\u016f<\/em><em>vodce laboratorn\u00edmi n\u00e1lezy. <\/em>Praha: Dr. Josef Raabe, s. r. ; 2012.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. &nbsp; Klinick\u00fd v\u00fdznam a defin\u00edcia Klinicky z\u00e1va\u017en\u00e1 hypoglyk\u00e9mia je stav, ktor\u00fd vedie k poruche mozgov\u00fdch funkci\u00ed v d\u00f4sledku neuroglykop\u00e9nie, protrahovan\u00e1 nelie\u010den\u00e1 hypoglyk\u00e9mia sa kon\u010d\u00ed k\u00f3mou a smr\u0165ou. Najm\u00e4 v \u010dase<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[289],"tags":[713,645],"class_list":["post-1106","post","type-post","status-publish","format-standard","hentry","category-biochemistry","tag-hypoglycemia","tag-laboratory-diagnosis","typ_clanku-review-article"],"acf":{"abstrakt":"<p>Hypoglycemia is low blood glucose concentration related to typical clinical symptoms. It is most often prevalent as an acute complication in diabetic patients, mainly those who are treated with intensified insulin regimens. Hypoglycemia caused by other reasons may be a part of diverse range of diseases and conditions linked with disorders of regulation of glucose homeostasis. Laboratory tests are a part of differential diagnosis of hypoglycemia in both patient groups.<\/p>\n<p><strong>Key words: <\/strong>hypoglycemia, laboratory diagnosis<\/p>\n","casopis":[{"ID":995,"post_author":"7","post_date":"2016-11-16 12:14:30","post_date_gmt":"2016-11-16 11:14:30","post_content":"<h4><strong>Biochemistry <\/strong><\/h4>\r\n<ul>\r\n \t<li>Biochemical inflammation markers<\/li>\r\n \t<li>Biochemical examinations in liver diseases<\/li>\r\n \t<li>Biochemical diagnosis in diseases of GIT<\/li>\r\n \t<li>Hypoglycemia<\/li>\r\n \t<li>Urolithiasis as a result of metabolic diseases<\/li>\r\n \t<li>Indication and application of tumor markers in clinical practice<\/li>\r\n \t<li>Monoclonal gammopathies \u2013 laboratory examinations in diagnosis and monitoring<\/li>\r\n \t<li>Hormones in diagnosis of reproductive function disorders<\/li>\r\n \t<li>Cerebrospinal fluid diagnosis of diseases affecting the nervous system<\/li>\r\n \t<li>Determining trace elements in blood serum<\/li>\r\n<\/ul>\r\n<h4><strong>Genetics<\/strong><\/h4>\r\n<ul>\r\n \t<li>Assessing the therapeutic response in patients with chronic myelocyte leukemia treated with tyrosine kinase inhibitors<\/li>\r\n \t<li>Hormones in diagnosis of reproductive functions\u2019 disorders<\/li>\r\n<\/ul>\r\n<h4><strong>Hematology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Anemias \u2013 laboratory diagnosis of the most frequently prevalent types of anemia<\/li>\r\n \t<li>Laboratory and hematological technical equipment<\/li>\r\n<\/ul>\r\n<h4><strong>Immunology <\/strong><\/h4>\r\n<ul>\r\n \t<li>Paraneoplastic neurological syndromes and in vitro diagnosis of onconeural antibodies<\/li>\r\n<\/ul>","post_title":"newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab","to_ping":"","pinged":"","post_modified":"2017-08-16 21:40:20","post_modified_gmt":"2017-08-16 19:40:20","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"50","upload_clanok":{"ID":1107,"id":1107,"title":"prokopcakova_hypoglykemie","filename":"Prokop\u010d\u00e1kov\u00e1_Hypoglyk\u00e9mie.pdf","filesize":127806,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/Prokop\u010d\u00e1kov\u00e1_Hypoglyk\u00e9mie.pdf","link":"https:\/\/www.newslab.sk\/en\/hypoglycemias\/prokopcakova_hypoglykemie\/","alt":"","author":"7","description":"","caption":"","name":"prokopcakova_hypoglykemie","status":"inherit","uploaded_to":1106,"date":"2016-12-11 16:04:16","modified":"2016-12-11 16:04:16","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1106","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1106"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1106\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1106"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1106"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1106"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}