1/13. Management of unexplained coma in children.coma in children is uncommon and can pose difficulties in diagnosis and management. resuscitation should concentrate on management of the airway, breathing and circulation and on rapid exclusion of easily correctable conditions, e.g. hypoglycaemia. Common causes of coma are considered and the diagnostic evaluation of these children is discussed. A case of a toddler in coma is discussed from the perspective of the accident and emergency department to illustrate the management of these challenging but uncommon patients.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
2/13. adult presentation of MCAD deficiency revealed by coma and severe arrythmias.We report the case of a 33-year-old man who presented with headaches and vomiting. Soon after admission he became drowsy and agitated, developed ventricular tachycardia and his neurological state worsened (Glasgow coma score 6). Blood analysis showed respiratory alkalosis, hyperlactacidemia (8 mmol/l), hyperammonemia (390 micro mol/l) and hypoglycaemia (2.4 mmol/l). Subsequently, he developed supraventricular tachycardia, ventricular tachycardia and ultimately ventricular fibrillation resulting in cardiac arrest, which was successfully treated. A CT scan of the head revealed cerebral oedema. Whilst in the intensive care unit, he developed renal failure and rhabdomyolysis. The metabolic abnormalities seen at the time of admission normalised within 48 h with IV glucose infusion. Biological investigations, including urinary organic acids and plasma acylcarnitines, showed results compatible with MCAD deficiency. mutation analysis revealed the patient was homozygous for the classical mutation A985G. This is one of only a few reports of severe cardiac arrhythmia in an adult due to MCAD deficiency. This condition is probably under-diagnosed in adult patients with acute neurological and/or cardiac presentations.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
3/13. Carboxyatractyloside poisoning in humans.OBJECTIVE: Cocklebur (xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed. SUBJECTS AND methods: The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death. RESULTS: Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium. CONCLUSIONS: Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
4/13. Prolonged hypoglycaemia after insulin lispro overdose.insulin lispro has a more rapid onset and a shorter duration of hypoglycaemic action than regular insulin. We report a 39-year-old woman, with no previous medical history, who injected 300 U of the insulin lispro (Humalog) in an attempted suicide. Half an hour later, she was found comatose and brought to our emergency department. On arrival, she was comatose, with capillary glucose of 0.4 mmol/L. She awoke after a 50 ml intravenous bolus of 50% glucose. A continuous infusion of 10% glucose was started. Intermittent hypoglycaemia with neurological signs requiring treatment with 50% glucose was recorded three times during subsequent hospitalization, the last episode being 11 h after insulin injection. The plasma insulin level 4 h after injection was 1465 mU/L, and 18 h after injection was 11 mU/L. Hypoglycaemia after an insulin lispro overdose may last for more than 11 h. Repeated hypoglycaemia after an insulin overdose could be avoided with a glucose infusion rate equivalent to the maximal glucose disposal rate.- - - - - - - - - - ranking = 6keywords = hypoglycaemia (Clic here for more details about this article) |
5/13. Multifactorial hypoglycaemic coma in female bodybuilder.A 31-year-old female bodybuilder who was admitted to the Clinic because of deep coma and hypoglycaemia was presented. For last six weeks she had been preparing for a competition doing aerobic and anaerobic exercises, ingesting rich-protein and low-carbohydrate diet and administering a low dose of somatotropin every day. Even for the regional competitions there is a need for exact doping check among young athletes. growth hormone in a small dosage taken together with low-carbohydrate and rich-protein diet can provoke deep hypoglicemia among people who use it for doping purposes.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
6/13. Hypoglycaemic brittle diabetes successfully managed by social worker intervention.The case is presented of a 39-year-old Type 1 diabetic patient of 22 years duration with recurrent hypoglycaemic comas. He was of unusual personality and had bizarre ideas on self-regulation of his diabetes, resulting in wide variations of insulin dosage. In one 12-month period he had 88 separate admissions to an emergency department with severe hypoglycaemic coma requiring intravenous glucose administration. The cycle of admissions was eventually broken by the intervention of a social worker, who provided structured non-medical support. The patient's diabetic misconceptions remained, but he appeared to gain sufficient insight to prevent recurrent hypoglycaemia.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
7/13. Hypoglycaemic coma associated with anorexia nervosa.Profound hypoglycaemia is a rare event which has been described in seven cases of anorexia nervosa. A further case is reported here and the literature regarding this complication is reviewed. The major risk factors identified are body weight below 30 kg, a period of fasting and intercurrent infection. Excessive exercise may also play a role. The precise pathogenesis has not been elucidated but several mechanisms, including depletion of liver glycogen, defective gluconeogenesis or failure of glucagon secretion have been proposed. Although hypoglycaemic coma frequently results in death, prompt treatment may result in full recovery as occurred in the case described here.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
8/13. Hypoglycaemic coma associated with gastric carcinoma.Gastric carcinoma may rarely be the cause of tumour-associated hypoglycaemia. We report the case of an elderly woman who presented in hypoglycaemic coma, and who was found subsequently to have an adenocarcinoma of the stomach. Hypoglycaemia persisted despite prednisolone, diazoxide, and a high concentration dextrose infusion. The few published cases are reviewed in which an association was established between gastric carcinoma and hypoglycaemia, and the possible aetiology of the hypoglycaemia is discussed.- - - - - - - - - - ranking = 3keywords = hypoglycaemia (Clic here for more details about this article) |
9/13. Severe hypoglycaemia and sudden death in anorexia nervosa.Two patients with severe anorexia nervosa developed hypoglycaemic coma which was fatal in one case. physical exertion may have contributed to this complication.- - - - - - - - - - ranking = 4keywords = hypoglycaemia (Clic here for more details about this article) |
10/13. Hypoglycaemic coma in severe primary hypothyroidism.A 76-year-old woman was admitted to the hospital in comatose condition. Her blood glucose was 1.7 mM. Immediately after intravenous glucose treatment she attained normal consciousness. The diagnosis of severe primary hypothyroidism was subsequently made and no sign of other diseases was detected. After thyroid replacement therapy fasting blood glucose levels rose to normal and no further hypoglycaemic episodes occurred. It is emphasized, that hypoglycaemia may be the direct cause of severely impaired consciousness in hypothyroidism requiring immediate and specific therapy.- - - - - - - - - - ranking = 1keywords = hypoglycaemia (Clic here for more details about this article) |
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