RESUMO
We report a case of reactive hypoglycemic coma in a 77-year-old man. Seven months after partial gastrectomy for early gastric cancer, he presented with syncopal attacks and seizure. His plasma glucose and insulin levels at coma were 18 mg/dl and 27μU/ml. Insulinoma was neglected with computerized tomography, magnetic resonance imaging and angiography. Because dietary control was insufficient, oral diazoxide therapy was done. But diazoxide did not protectthe overresponse of the insulin and reactive hypoglycemia in 75 g GTT. Octreotide (100 micrograms IM) inhibited insulin release and prevented hypoglycemia. Acarbose delayed the response of insulin butdid not inhibited insulin release. However, acarbose also prevented reactive hypoglycemia. We concluded that acarbose is an effective therapy for reactive hypoglycemic coma.
RESUMO
The patient was a 56-year-old male. He had a history of alcoholism since 1975 and diabetes mellitus since 1978. He was treated with insulin therapy. But the control of diabetes mellitus was very poor and he had six hypoglycemic comas attacks. He had diabetic triopathy but no symptoms of gait disturbance, dementia and incontinence. Brain computerized tomography and magneting resonance imaging revealed severe communicating hydrocephalus with mild brain atrophy.<SUP>111</SUP>In-DPTA cisternography revealed retension of isotope in the ventricle after 48 hours. The pressure of cerebrospinal fluid was normal.<BR>This case report is interesting as it suggests the relationship between normal pressure hydrocephalus and hypoglycemia.
RESUMO
An 78-year-old woman visited our hospital with the chief complaints of abdominal pain, nausea, vomiting and diarrhea. She was operated on for gastric ulcer when she was 56 years old and complained of abdominal discomfort after operation. One day she wished to take Confrey (<I>Symphytum officinale</I>), but she took digitalis leaves (<I>Digitalis purpurea</I>) by mistake. On admission she was drowsy and the systolic blood pressure was 60 mmHg on palpation. Electrocardiograms showed bradycardia, irregular AV-nodal rhythm and ST depressions and T wave inversions with the shortening of the QT interval. Serum levels were potassium, 6.4 mEq/1 ; BUN, 34.4 mg/di ; creatinine, 1.5 mg/di ; digoxin, 2.0 ng/ml (therapeutic level, up to 2.0 ng/ml); and digitoxin, 111ng/ml (therapeutic level, up to 25 ng/ml). Hemodynamic data showed HR, 49 beats/min ; CO, 2.81/min; CI, 2.31/min/m<SUP>2</SUP>; SV, 57 ml/beat and SI, 47 ml/beat/m<SUP>2</SUP> on administration of dopamine 7μg/kg/min. So VVI pacing was started at 70 bpm and CO increased to 3.6 1/min after pacing. But unfortunately she died of ventricular fibrillation. The digitalis leaves resemble the Confrey leaves and it is easy to mix up these two plants. Although this is a rare case, digitalis intoxication can be life-threatening. So we should prepared ourselves for the treatment of patients poisoned with digitalis and other poisonous herbs.