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Washington University Experience | METABOLIC | Hypoglycemia | 1A0 - Case 1 History
Case 1 History ---- The decedent was a 28 year old woman who initially presented with shortness of breath, fever and cough. She was treated for a respiratory infection which did not improve resulting in pneumonia and acute respiratory failure. Blood cultures grew Vancomycin-resistant enterococci and Candida. On hospital day 28, the patient was inadvertently placed on an insulin drip for 3 hrs. The patient became unresponsive and had an Accu-check value of 14 (i.e., marked hypoglycemia). She was resuscitated with D-50 but failed to regain any significant cognitive function thereafter. She then became febrile with an increased WBC count and was started on antibiotics. An MRI of the brain showed corpus striatum and thalamic changes thought consistent with hypoglycemia. Multiple positive blood cultures grew Pseudomonas and Enterococcus. In addition, tracheal aspirates at various times grew S. aureus, Pseudomonas and Klebsiella. She was treated with multiple antibiotics and about one week prior to death developed acute renal failure presumably secondary to gentamycin. At this time, a decision was made by the family not to advance the level of care and she died two months after her insulin hypoglycemic episode.
