Case Presentation
A 55‑year‑old man presented to the Emergency Department with sudden loss
of consciousness. His blood glucose level was 20 mg/dl. He was
immediately resuscitated with intravenous dextrose infusion and his
mental status improved to baseline with adequate increase in blood
glucose. The patient reported dizziness, weakness and blurred vision
preceding his loss of consciousness. This symptomatology occurred for
one month twice a week.
Past medical history included only schizophrenia treated with
Haloperidol and Trihexyphenidyl since 25 years. The patient had history
of chronic alcohol use but he didn’t drink alcohol since one month. He
was lethargic and his BMI was 18.2 kg/m2. Clinical
examination noted a hard and an irregular hepatomegaly with collateral
venous circulation. No splenomegaly was found. His cardiovascular and
respiratory system findings were within normal limits.
Laboratory parameters are shown in Table 1. During the hypoglycemic
episode we measured insulin, C-peptide and cortisol. Drug screens for
sulfonylureas and other insulin secretagogues were negative.
Table 1: Laboratory data of the reported patient.