Abstract: PUB474
Unexplained Severe and Recurrent Hypoglycemia in a Patient with History of Miliary Tuberculosis, Systemic Lupus Erythematosus (SLE), and ESKD on Chronic Hemodialysis
Session Information
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Bernardo, Jose F., Clinica Medica Cayetano Heredia, Lima, Peru
- Dominguez, Marco A., Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
- Valenzuela, Carlos Raul, Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
Introduction
Hypoglycemia is defined by a plasma glucose below 70 mg/dl, with symptoms usually manifest whenever the levels are less than 55 mg/L. The brain needs continuous supply of glucose as a fuel. During fasting state, the serum glucose level is maintained as a result of the gluconeogenesis and glycogenolysis by theliver. Coma is usually the most common presentation of severe hypoglycemia. We describe a patient on chronic hemodialysis with adequate oral intake presenting with recurrent episodes of agitation and seizures related to hypoglycemic attacks
Case Description
34 years old male with history of ESRD on HD, hypertension, had a recent diagnosis of miliary tuberculosis (on standard dose reatment with isoniazid, rifampim, ethambutol and pirazinamide. He also a diagnosis of Systemic Erythematous Lupus, on maintenance with hydroxycloroquine. He was admitted on April 2024 for an episode of severe hypoglycemia. A month later he was admitted with 1 week of progressive weakness, dyspnea on exertion, agitation and confusion. On admission blood glucose was reported at 55 mg/dl atributed to poor oral intake. The patient presented to the ER with an episode of clonic-tonic seizures with loss of consciousnes for one hour. There was no history of decreased oral intake, nausea or vomiting and he was compliant with HD sessions. On admission: had a BP 122/68 mmHg, HR 110 bpm, afebrile, POx 94% on room air. Oral mucosa hydrated, no significant edema. Neurological exam: stupurous, no focal motor deficits. Imaging studies were non revealing. Blood glucose level was 65 mg-dl. He was managed with Dx10% for several hours with a persistent blood glucose of less than 100 mg/dl. An ACTH level was 26.87 pg/ml (7.20-63.30 pg/ml.
Discussion
Our patient was compliant with his chronic HD and medication, There was no history of depression. His food intake was closely observed while in the hospital. During his hospital stay, had repeated episodes of severe hypoglycemia. Diagnostic studies did not suggest the presence of an adrenal infarction and(or the presence of an insulinoma. His prescription of hydroxycloroquine was discontinued with marked and rapid improvement of his glucose levels. Hypoglycemia as a side effect of hydroxycloroquine has been previously described, the incidence however has not been well established.