Story From The Front Lines An older woman with a history of insulin-dependent type 2 diabetes and metastatic breast carcinoma presented for positron emission tomographic (PET) surveillance of her cancer. There was no institutional policy on PET scan preparation for patients with diabetes, so her status was nil per os (NPO) for the scan, but she took her regular dose of insulin, a sulfonylurea, and metformin as scheduled. The PET scan was cancelled when she had a syncopal episode. When she was seen in the emergency department, she was noted to have a blood glucose level of 19 mg /dL (1.05 mmol/L) and an oxygen saturation level of less than 92%. Findings from her physical examination and initial workup caused concern for a pleural effusion, so her status was kept as NPO per hospital policy for a computed tomographic (CT) scan of her chest, which confirmed an effusion; pleural fluid analysis supported a malignant etiology. The patient elected to pursue curative treatment of her cancer, so her status was kept as NPO again for a restaging CT. Later that day, she fell in her hospital room, which necessitated NPO status for a CT scan of her head, revealing cerebral metastases of her cancer and ruling out intracranial hemorrhage. During her hospitalization, the patient’s blood glucose level remained labile, and despite ordering fall precautions, she had multiple falls; fortunately, none of these resulted in serious injury.

中文翻译：

---

Nil per Os Orders for Imaging

来自前线的故事 一位有胰岛素依赖型 2 型糖尿病和转移性乳腺癌病史的老年妇女就她的癌症进行了正电子发射断层扫描 (PET) 监测。没有关于糖尿病患者 PET 扫描准备的机构政策，因此她的扫描状态为 nil per os (NPO)，但她按计划服用了常规剂量的胰岛素、磺脲类药物和二甲双胍。当她有晕厥发作时，PET 扫描被取消。当她在急诊科就诊时，注意到她的血糖水平为 19 mg/dL (1.05 mmol/L)，氧饱和度水平低于 92%。她的体格检查和初步检查的结果引起了对胸腔积液的担忧，因此根据医院的政策，她的胸部计算机断层扫描 (CT) 扫描将她的身份保留为 NPO，确认有积液；胸水分析支持恶性病因。患者选择对她的癌症进行根治性治疗，因此她的身份再次保留为 NPO 进行再分期 CT。那天晚些时候，她在病房里摔倒了，这需要 NPO 状态才能对她的头部进行 CT 扫描，显示癌症的脑转移并排除颅内出血。在住院期间，患者的血糖水平仍然不稳定，尽管采取了跌倒预防措施，但她还是多次跌倒；幸运的是，这些都没有造成严重伤害。这需要 NPO 状态才能对她的头部进行 CT 扫描，揭示她癌症的脑转移并排除颅内出血。在住院期间，患者的血糖水平仍然不稳定，尽管采取了跌倒预防措施，但她还是多次跌倒；幸运的是，这些都没有造成严重伤害。这需要 NPO 状态才能对她的头部进行 CT 扫描，揭示她癌症的脑转移并排除颅内出血。在住院期间，患者的血糖水平仍然不稳定，尽管采取了跌倒预防措施，但她还是多次跌倒；幸运的是，这些都没有造成严重伤害。