A 66-year-old female patient regularly received nifedipine sustained release tablets 20 mg twice daily and captopril 25 mg once daily by mouth for 2 years due to hypertension. Low blood glucose (3.0 mmol/L) appeared in recent 1 year, frequent hypoglycemic coma occurred in recent 4 months. Laboratory tests showed minimum fasting glucose 1.6 mmol/L, insulin 12 mU/L, C-peptide 1.78 nmol/L, and positive anti-insulin antibody. Insulin autoimmune syndrome was considered, which might be associated with captopril. Then captopril was stopped, nifedipine sustained-release tablets was continued, irbesartan hydrochlorothiazide was added, and prednisone 30 mg orally once daily was given at the same time. In addition, the patient was asked to adjust diet, including low carbohydrate and eating less and often. After stopping captopril for 3 days, her blood glucose was between 4.3 to 11.2 mmol/L, and hypoglycemia did not recur.

A 66-year-old female patient regularly received nifedipine sustained release tablets 20 mg twice daily and captopril 25 mg once daily by mouth for 2 years due to hypertension. Low blood glucose (3.0 mmol/L) appeared in recent 1 year, frequent hypoglycemic coma occurred in recent 4 months. Laboratory tests showed minimum fasting glucose 1.6 mmol/L, insulin 12 mU/L, C-peptide 1.78 nmol/L, and positive anti-insulin antibody. Insulin autoimmune syndrome was considered, which might be associated with captopril. Then captopril was stopped, nifedipine sustained-release tablets was continued, irbesartan hydrochlorothiazide was added, and prednisone 30 mg orally once daily was given at the same time. In addition, the patient was asked to adjust diet, including low carbohydrate and eating less and often. After stopping captopril for 3 days, her blood glucose was between 4.3 to 11.2 mmol/L, and hypoglycemia did not recur.

Objective: To study the characteristics and clinical appearence of polymyositis (PM ) or dermatomyositis (DM)combined with thyroid diseases,and to analyze the clinical significance.Methods:Total 77 patients first diagnosed as PM or DM were selected.All the patients were divided into four groups according to their thyroid functions,which were normal thyroid function group,low T3 syndrome group,hypothyroidism group, and subclinical hypothyroidism group.Their clinical manifestations,laboratory features,immunological examination results and prognosis were collected and analyzed.Results:In all the PM/DM patients,there were 41 cases with thyroid disfunction, including 17 cases (41.46%)with low T3 syndrome (41.46%).Compared with normal thyroid function group,the patients in hypothyroidism group were more vulnerable to dysphagia and edema (P <0.05);the proportion of proteinuria was also significantly increased (P <0.05).The PM/DM patients with low T3 syndrome were more easier to have higher incidence of death,higher level of C-reactive protein and lower levels of albumin and calciumion as well as higher incidence of edema and pleural effusion (P < 0.05 ).Conclusion:The incidence of PM/DM combined with thyroid disfunction is higher,and low T3 syndrome is most common.The PM/DM patients with hypothyroidism and low T3 syndrome are more likely to suffer the digestive system,lung and kidney injuries.The patients with low T3 syndrome have a higher death rate.

OBJECTIVE:To improve the safety management level of high-risk drug Insulin injection in our hospital. METH-ODS:The standard management of Insulin injection(400 u/injection)was conducted by using PDCA(plan-do-check-action). The application of Insulin injection in wards was compared before and after six months of management. RESULTS:By strengthening training,improving ward baseline insulin management register system,adjusting the specification of insulin in information system, etc.,the application and storage of insulin became more standard;no expired drugs occurred;the rate of waste drug decreased from 95.06% before management to 22.00% after management,decreasing by 73.06%. CONCLUSIONS:PDCA cycle can im-prove the safety management of Insulin injection in wards effectively.