July - September 2009, Volume 5, Issue 3

Sorodoc L, Lionte C, Sorodoc V, Petris O, Badiu C

Causes, morbidity and management of drug-induced hypoglycemic coma in non-diabetic patients

Acta Endo (Buc) 2009, 5 (3): 337-348
doi: 10.4183/aeb.2009.337

Introduction. In the community, hypoglycemic coma is commonly caused by therapies for diabetes mellitus, or excessive alcohol consumption. Little information is available on the causes and outcome of hypoglycemic coma in non-diabetic patients. Patients and Methods. We retrospectively surveyed adult patients admitted to a regional emergency hospital with hypoglycemic coma in a 18-years period, identifying 80 admissions of 79 patients. 72 cases (91.14%) presented hypoglycemic coma induced by anti-diabetic medications in attempted suicide. The others had hypoglycemic coma induced by deliberate selfpoisoning with other drugs influencing glucose metabolism, sometimes associated with excessive consumption of alcohol. Results. A history of psychiatric illness was present in 15 patients (19%), and 2 cases (2.53%) had chronic alcoholism. Neurological manifestations of hypoglycemia were the principal reason for admission, observed in all patients, and 15 patients (19%) had precipitated convulsions. Although some patients received treatment for hypoglycemia before admission, hypoglycemia recurred in 12 cases (15.19%) in hospital. Morbidity included ventricular arrhythmias (8.86%), non-cardiogenic acute pulmonary edema (1.26%), and transient neurological disturbances, in 2 elderly patients. Two cases died following admission, but death was not the direct result of hypoglycemia. Therapeutic measures consisted in antidote therapy, toxin removal, and supportive therapy. Conclusion. Though drug-induced hypoglycemic coma is rarely encountered in medical practice (2.44% in our study), management of these patients represents a challenging task in every practitioner.

Keywords: hypoglycemic coma, non-diabetic, drug intoxication

Correspondence: L.Sorodoc, “Sf. Ioan” Emergency Clinic Hospital, 2, Gen Berthelot str., Iasi, 700483, Romania Phone:+40722776247, fax: +40232216518; e-mail: laurentiusorodoc@yahoo.com