Shu–Hua Wang, Yin–Hsun Feng

This case describes a 52–year–old male patient with stage III esophageal cancer and no prior history of diabetes mellitus. During chemotherapy, he experienced a weight loss exceeding 5% of his baseline weight without typical cancer–related symptoms such as anorexia, weakness, or dysphagia.

A differential diagnosis for the weight loss excluded tumor progression and other chronic diseases. Further assessment revealed the classic diabetic symptoms of polyuria, polydipsia, and polyphagia. Blood glucose testing showed a level of 928 mg/dL, confirming a diagnosis of hyperosmolar hyperglycemic state (HHS). Immediate insulin therapy and close glucose monitoring were initiated during hospitalization.

Early recognition and timely management of HHS prevented severe complications such as coma, renal failure, shock, and even death, allowing the patient to successfully complete the chemotherapy course. This case prompted the healthcare team to re–evaluate the importance of routine blood glucose monitoring for patients undergoing chemotherapy, reinforcing clinical vigilance and preventive strategies to ensure patient safety.

王淑華，馮盈勳

本案例為一位 52 歲食道癌第三期男性患者，既往無糖尿病病史。於化學治療期間，發現其體重減輕超過 5%，但無典型癌症患者的食慾減退、虛弱或吞嚥困難等症狀。針對該體重變化進行鑑別診斷後，排除腫瘤惡化與其他慢性疾病，並確認其具備糖尿病「三多一少」症狀。隨即進行血糖檢測，結果顯示血糖高達 928 mg/dL，最終診斷為高滲透壓高血糖狀態 (hyperosmolar hyperglycemic state, HHS)。

住院期間立即施以胰島素治療並密切監控血糖變化。由於及早診斷並即時處置，成功避免昏迷、腎衰竭、休克甚至死亡等嚴重併發症，患者得以順利完成化療療程。此案例促使醫療團隊重新檢視化療患者入院時血糖監測的重要性，進一步強化臨床警覺性與預防機制，以確保病人生命安全。