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Washington University Experience | METABOLIC | Hypoglycemia | 3A0 - Case 3 History
Case 3 History ---- The patient was a 34-year-old woman with a medical history significant for depression, migraines, asthma and hypertension. The patient apparently experienced an episode of visual hallucinations and agitation. Later she collapsed while shopping. She was taken in an unresponsive state to an outside hospital, where her blood glucose was found to be 29 mg/dcl. She was treated with D50 and promptly recovered. However, she left the hospital against medical advice before work-up could be completed. On the following morning the patient's husband was notified at work that friends and family were unable to reach the patient by phone. He returned home to find the patient unresponsive. Blood glucose on presentation was again in the 20s. A complete workup was undertaken. Electroencephalogram showed positive spikes in the right frontal area and some burst suppression. Peripheral white blood cell count was elevated at 18.8, with 90% PMNs. Magnetic resonance imaging showed mildly increased T2 and FLAIR signal and mild restrictive diffusion in the basal ganglia bilaterally as well as a more generalized gyriform patterns seen throughout the cortex, consistent with hypoglycemic encephalopathy. Insulin and C-protein levels were, however, within normal limits. The patient's family reported finding Glipizide among her prescribed medications. It was felt that her hypoglycemic episode was mostly likely the result of a glipizide overdose. After several days in the outside hospital with little change in status, the patient was transferred to our hospital for further care. After extensive discussions of the patient's poor prognosis among clinicians and the patient's family, the decision was made to withdraw care. The patient died 2 weeks following her initial collapse.
