Furthermore, harmful effects of severe hypoglycemia and multiple hypoglycemic episodes during tight glucose control in critically ill patients have been recently demonstrated (2).
Kalfon P, Le Manach Y, Ichai C, Brechot N, Cinotti R, Dequin PF, Riu-Poulenc B, MontrAnnaneP, Annane D, Dupont H et al: Severe and multiple hypoglycemic episodes are associated with increased risk of death in ICU patients.
In a large cohort of ICU patients, severe hypoglycemia and multiple hypoglycemic events were associated with increased 90-day mortality.
Multiple hypoglycemic events (any type, n ≥3) occurred in 482 patients (19%; 95% CI, 17% to 20%), and their 90-day mortality was significantly increased compared with patients with fewer hypoglycemic events (51% vs. 29%; P <0.001).
At the same time, medical therapies containing multiple hypoglycemic strategies had always caused additional problems, regarding to low rates of adherence, high rates of side effects, and hypoglycemic events [ 24].
However, our analysis of the first 500 patients seen in a newly opened five-bed Emergency Department (ED) at Nyakibale Karoli Lwanga Hospital in rural southwestern Uganda, revealed multiple intoxicated patients who presented in hypoglycemic coma within hours of eating a full meal.
It was quickly determined that she was in a hypoglycemic coma, which is most commonly caused by self-administered glucose-lowering drugs that diabetics use, such as insulin.
"The sample showed Mr Misell was deeply in a hypoglycemic coma".
It is even more rare to see an intoxicated patient, who had been eating appropriately prior to or during the intoxication, present in a hypoglycemic coma.
Patient 1 presented with prolonged hypoglycemic coma, patient 2 with intracerebral hemorrhage, patient 3 with central and extra pontine myelinolysis, patient 4 with a brainstem hemorrhage.
