1/30. Hypoketotic hypoglycemic coma in a 21-month-old child.We present the case of a 21-month-old child with hypoketotic hypoglycemic coma. The differential diagnosis initially included metabolic causes versus a toxicologic emergency (unripe ackee fruit poisoning). Using information obtained from the emergency department, the diagnosis was confirmed as the late-onset form of glutaric acidemia type II. This case illustrates the importance of emergency physicians in the diagnosis and management of children with inborn errors of metabolism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/30. hemiplegia hypoglycaemia syndrome.We report the case of a 83-year-old man who presented to the emergency department with hypoglycaemia resembling a cerebrovascular accident. Hypoglycaemic hemiparesis is an under-recognized manifestation of hypoglycaemia. If not recognized and treated promptly, hypoglycaemia may cause irreversible central nervous system injury; it rarely results in death. It is imperative that emergency physicians consider hypoglycaemia in all patients with coma in spite of focal neurological deficit even when the findings seem to be explained initially by other aetiologies.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/30. Important causes of hypoglycaemia in patients with diabetes on peritoneal dialysis.AIM: Diabetes is now the commonest cause of end-stage renal failure, so there are many diabetic patients receiving dialysis therapy. There are several important ways in which dialysis practice can impinge unfavourably on glucose control. This study focuses on the interaction between maltose-derived metabolites in a new peritoneal dialysis fluid and blood glucose measurements using reagent sticks that depend on the glucose dehydrogenase method. CASE REPORT: We report the cases of three patients, with insulin-treated diabetes and end-stage renal disease treated with peritoneal dialysis, who experienced symptomatic hypoglycaemia with inaccurate glucose readings on reagent strips when converted to icodextrin. CONCLUSION: Careful teamwork between diabetes and renal physicians and specialist nurses is highly desirable to achieve good glucose control in a group of patients at particular risk of microvascular and macrovascular complications.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/30. A mouthful of trouble.The prehospital providers in this case performed a thorough and detailed assessment. They searched for and found a puncture wound in the posterior buccal region, and learned the patients was also hypoglycemic, with a history of diabetes, and insulin-dependent. It was not clear how the patient arrived at a hypoglycemic state, or if he had suffered a seizure. After the family arrived at the hospital and went to the patient's home, they determined the circumstances that caused this unusual presentation: The patient was the victim of a home-invasion robbery and had been shot in the mouth with a small-caliber weapon. The home invasion had taken place approximately 12 hours prior to the victim being found. The victim had been knocked unconscious by the force of the shot, although the bullet did not break any bones. He had not eaten prior to the shooting. Upon arrival at the ED, a small exit wound was noted behind the patient's left ear--hair and dried blood had obscured it from the prehospital providers. However, the providers did alert the ED physician to the buccal puncture wound, which enabled the physician to consider the possibility that the mouth wound was the result of a gunshot. Gunshot wounds are unpredictable in their damage patterns and effects on their victims. They might lead a patient to become hemodynamically unstable, but that was not the case here. Hemodynamic stability should not preclude the consideration of traumatic insult throughout your assessment. The initial presentation of this patient may have tempted EMS to pursue the suspicions stated by the neighbor at the scene (seizure), but a detailed assessment provided the information necessary to treat the man appropriately.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/30. Individualizing insulin management. Three practical cases, rules for regimen adjustment.Many patients with diabetes become frustrated by the tedium of inflexible insulin instructions and unpalatable dietary restrictions. They lose confidence when their blood glucose levels fluctuate widely, and they may begin to think of themselves as "bad diabetics." Therefore, choosing the appropriate insulin and injection regimen for each patient is essential. Coordinated efforts by a concerned team of diabetes educators, dietitians, and physicians enhance the effectiveness of treatment. patients should be taught how to count carbohydrates, select foods with a low glycemic index, and adjust their insulin regimen by using sliding scales based on the 1500 or 1800 rule. Regular exercise and solid emotional support from family and friends also are helpful. By teaching patients the rules for insulin management, physicians can empower them to be much more actively involved in their own care and to lead healthier lives.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/30. Unexpected hypoglycemia in a critically ill patient.Administration of the wrong medication is a serious and understudied problem. Because physicians are not directly involved in the drug administration process, they tend to overlook the possibility of adverse drug events and medication errors in their differential diagnoses of patient illnesses or acute deterioration. This article analyzes the case of a patient with iatrogenic hypoglycemia due to administration of the wrong medication: Insulin instead of heparin was used to flush the patient's arterial line. In addition to assessing the results of the institution's "root-cause analysis" of the factors contributing to this particular adverse event and the institution's response, this article reviews the literature on preventing medication errors. Key strategies that might have been helpful in this case include using checklists for common emergency conditions (such as altered level of consciousness) and automated paging for "panic laboratory values," as well as instituting protocols for medication administration. Changing the system of administering medications by bar coding drugs, with checks of the medication, patient, and provider, could have prevented this accident. Finally, organizations need to strive for a "culture of safety" by providing opportunities to discuss errors and adverse events in constructive, supportive environments and by resisting pressure to find a scapegoat.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/30. hypoglycemia probably due to accidental intake of repaglinide.This report focuses on a 16-year-old girl afflicted with hypoglycemia after administration of medications for gastrointestinal symptoms. Repaglinide-induced hypoglycemia was suspected when a tablet of repaglinide was noted in the drug package that she had been given. As the use of various types of oral hypoglycemic agents has increased, a definitive diagnosis of drug-induced hypoglycemia has become difficult. It is dangerous for a patient to take oral hypoglycemic agents without the knowledge of hypoglycemic symptoms and initial management. We present this case and review the characteristics of repaglinide to remind physicians and pharmacists to pay more attention to this situation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/30. An unusual cause of hyperinsulinaemic hypoglycaemia syndrome.Endogenous hyperinsulinism as a cause for hypoglycaemia can be attributed to a number of different causes including insulinoma, sulphonylurea drugs and the newly described disorder non-insulinoma pancreatogenous hypoglycaemia (NIPH). The calcium stimulation test is increasingly used as a method for not only localizing insulinoma but also for distinguishing the above entities. We describe a case in which felonious sulphonylurea administration was used to mimic either an insulinoma or NIPH. Importantly, this case demonstrates that, contrary to previous reports, the insulin response to calcium stimulation in such cases may be uniformly positive and should alert the physician to possible surreptitious sulphonylurea ingestion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/30. Emergency presentation of an elderly female patient with profound hypoglycaemia.We present the case of an elderly non-diabetic female who was admitted to hospital as an emergency due to loss of consciousness. Her clinical presentation was consistent with hypoglycaemia due to a massive insulin overdose. However, the patient refuted the possibility of insulin administration, and the circumstances were reported to the police for investigation. This case demonstrates the clinical and biochemical characteristics of insulin overdose. Furthermore, it serves to illustrate the sequence of events that may be created when foul play is suspected, and the factors related to patient confidentiality that require consideration by the responsible physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/30. Are one or two dangerous? Sulfonylurea exposure in toddlers.Sulfonylurea-based oral hypoglycemics are in widespread use in the adult population, increasing the potential for unintentional exposure in children. This article examines the risk of toxicity in children under 6 years of age who ingest one to two tablets of a sulfonylurea. We review the literature on sulfonylurea toxicity, including cases reported to the American association of Poison Control Centers (AAPCC). The ingestion of one to two sulfonylurea tablets by a small child can lead to profound hypoglycemia with severe sequelae if untreated. As a result, all potential sulfonylurea ingestions by young children should be evaluated by a physician. A capillary glucose level must be rapidly determined at presentation and should then be repeated at regular intervals for up to 8 hours. A longer observation period is recommended for the extended release preparation of glipizide. Asymptomatic children who do not develop hypoglycemia within the recommended observation period may be safely discharged home. All children who exhibit clear symptoms of hypoglycemia or glucose levels < 60 mg/dL should be admitted for supplemental glucose (oral or intravenous), with careful observation of clinical condition and monitoring of serum glucose levels. In cases refractory to intravenous glucose, therapy with octreotide or diazoxide may be beneficial.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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