1/6. A case report of warm weather accidental hypothermia.A case of hypothermia is presented as a reminder to "Deep South" physicians that our warm weather is not prophylaxis against this syndrome; and many common situations, diseases and medications contribute to and worsen the condition. diagnosis is made by obtaining a true core body temperature and effective treatment modalities can be easily applied. With appropriate rewarming, a search for complications and monitoring of patient progress a gratifying outcome should result for both patient and physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Unexplained deaths of type 1 diabetic patients.The suggestion of an increase in the number of sudden deaths of young people with Type 1 diabetes in the UK has been investigated. It was suggested that such deaths were due to hypoglycaemia and related to the increasing use of human insulin. In total we were notified of 50 deaths of people with Type 1 diabetes under age 50 years in the UK in 1989 which our informants (relatives, physicians, and pathologists) considered sudden and unexpected. An autopsy had been done in all cases and we supplemented this with detailed clinical information from relatives and case records. Of the 50 cases we excluded five with a definite cause of death, 11 suicides or self-poisonings, six cases of ketoacidosis, and four in which there was insufficient information about the circumstances of death to drawn any conclusions. Of the other 24 cases, two patients had been found with irreversible hypoglycaemic brain damage and died after a period of artificial ventilation. The most puzzling group were 22, aged 12-43 years, most of whom had gone to bed in apparently good health and been found dead in the morning. Nineteen of the 22 were sleeping alone at the time of death and 20 were found lying in an undisturbed bed. Most had uncomplicated diabetes and in none were anatomical lesions found at autopsy. There are major difficulties in diagnosing hypoglycaemia post-mortem, but the timing of death and other circumstantial evidence suggests that hypoglycaemia or a hypoglycaemia-associated event was responsible. All patients were taking human insulin at the time of death but most had been changed from animal insulin between 6 months and 2 years earlier and there was nothing to implicate the species of insulin as a factor in these deaths.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/6. insulin-induced factitious hypoglycemic coma.hypoglycemia due to the ingestion of oral hypoglycemic agents or injection of insulin is a common way for chronic factitious disorder to present to physicians. Despite this fact, factitious hypoglycemic coma is rare. Because hypoglycemia is potentially fatal, with numerous sequelae, physicians need to be aware of its occurrence and method of detection. A case of chronic factitious disorder presenting as hypoglycemic coma is presented and its implications discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Factitious brittle diabetes mellitus.Five patients are described in whom factitious disease was the cause of brittle type I diabetes mellitus. The patients were referred from throughout the united states because their physicians had been unable to establish the reason for recurrent hospitalizations for diabetic ketoacidosis or coma. In three of the patients, unexplainable signs, symptoms, and/or laboratory results lead to the diagnosis of factitious disease. In the two remaining patients, long-term follow-up was necessary before a factitious cause was established. These five patients exemplify the extraordinary measures that some patients will utilize to continue as a "patient" rather than return to a normal lifestyle.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/6. Hypoglycemic coma associated with subcutaneous insulin infusion by portable pump.The incidence of hypoglycemia in insulin-dependent diabetic patients managed by continuous subcutaneous insulin infusion (CSII) has been reported to be very low. We report a case of hypoglycemia coma occurring in a highly compliant and intelligent patient while on CSII by a portable pump. Factors contributing to this episode included high risk off hypoglycemia due to tight control, failure to recognize early hypoglycemic symptoms, and maintenance of hypoglycemia for over 2 h by the open-loop device. hypoglycemia is a complication of CSII by portable pump. We join others in recommending its use solely by experienced physicians. Constant supervision of patients while on CSII is important to eliminate this potentially lethal complication.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/6. Attempted suicide using insulin by a non diabetic: a case study demonstrating the acute and chronic consequences of profound hypoglycemia.This paper describes the case of a non diabetic physician with a prior psychiatric history in which there was overwhelming biochemical and clinical evidence that he had attempted suicide by injecting himself with an overdose of insulin. He was extensively monitored from the time of his admission to hospital in a coma, until he fully recovered consciousness 30 days later and during the next eight months of his rehabilitation. This case attests to the high level of morbidity which might follow profound hypoglycemia. It also illustrates some putative psychodynamics of suicidal behaviour--notably ambivalence and denial (at the time of writing, the patient never acknowledged that he had overdosed with insulin). A selective review on some of the more recent literature on the neuropathological effects of insulin overdose and profound hypoglycemia is presented.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |