Hypoglycemia-Induced Loss of Consciousness in an Immobilized Geriatric Patient: A Case Report

Abstract

Introduction : Hypoglycemia in geriatric people is a less well recognized condition and have been correlated with acute outcomes such as seizure, coma, and cardiac arrhythmia. Symptoms of hypoglycemia tend to be less specific with ageing, where diagnosing these conditions in geriatric patient potentially becomes more difficult.

Case Report : A 77-year-old man was brought to the ER due to unresponsive since 2 hours before admission. He was hypoglycemic with a plasma glucose level of 70 mg/dL, hypoalbuminemia (2,6 g/dL), and hyponatremia (121 mmol/L).  After receiving intravenous dextrose, he regained consciousness and his plasma glucose level increased to 120 mg/dL. Electrolyte abnormalities were corrected, plasma glucose level monitored every 2 hours and titrated according to hypoglycemia standard procedure. He has been in total bed rest and immobilized for 5 years due to inferior paraparesis with decubitus ulcer, had a history of uncontrolled hypertension and diabetes mellitus. Physical examination showed reduced motor function in his lower extremities. The patient had significant recovery during the treatment course and was discharge 4 days after initial presentation.

Discussion : Hypoglycemia is a low plasma glucose concentration state that could leads to defective glucose counter-regulation and hypoglycemia unawareness. The patient’s long immobilized state potentially leads to a catabolic state that results in muscle wasting. While his reduced intake leads to geriatric anorexia and become the potential cause of hypoglycemia. Mainstay of hypoglycemic treatment is the detection and treatment using interventions that rapidly increased blood sugar to a safe level, eliminating injury risks and quickly relived symptoms.

Conclusion : Diabetes in geriatric has a higher risk for hypoglycemia and should be considered in treating an elderly patient presenting with unresponsiveness or loss of consciousness.