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.