Aashi
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A 20-year-old college student is brought to the emergency department by his girlfriend because of the sudden onset of a headache, shaking, sweating, and blurry vision. She says that he became very confused during the taxicab ride over to the hospital, asking, "where are you taking me to, the airport?" He was fully aware that they were going to the hospital as they left their apartment 5 minutes earlier. These symptoms started as they were lying in bed going to sleep, 3 hours after coming back from the local Italian restaurant, where they both ate fettucine alfredo. They did not drink any alcohol tonight. He has had similar, but milder, symptoms on four previous occasions in the past few years. He has no other medical conditions and does not take any medications. His temperature is 37.0 C (98.6 F), blood pressure is 100/70 mm Hg, pulse is 120/min, and respirations are 22/min. He is not oriented to person, place, or time. He begins to lose consciousness during the physical examination, which is otherwise unremarkable. At this time the most appropriate conclusion is:
A. He should drink a glass of orange juice immediately
B. An intravenous bolus of glucose as a 50 % solution should be given immediately
C. An intravenous bolus of isotonic saline should be given immediately
D. Naloxone, given intravenously every 2 minutes, will reverse this patient's symptoms
E. Physostigmine, given intravenously over 2 minutes, will reverse this patient's symptoms
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| prathapdoctor
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suspecting hypoglycemia,i will go for administering IV bolus of intrevenous glucose.
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| drashishmahajan
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me tooo B--- all others can be ruled out
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| chemamr
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I think B would be the first step.
can you tell why do you think guys the pt has hypoglycemia?
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| Aashi
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The correct answer is B.
This patient is most likely experiencing the symptoms of hypoglycemia, which should be treated with intravenous glucose until the patient can eat a meal. There are two categories of symptoms associated with hypoglycemia: the autonomic response and the neuroglycopenic response. The former is due to excessive secretion of epinephrine/norepinephrine and consists of tremor, palpitations, sweating, hunger, and anxiety. The latter is caused by central nervous system dysfunction and includes dizziness, headache, blurry vision, confusion, abnormal behavior, and a loss of consciousness. Symptoms do not usually occur until the blood glucose falls below 45 mg/dL. Causes of hypoglycemia include postprandial hypoglycemia, fasting hypoglycemia, insulinomas, and factitious hypoglycemia.
This patient should not have a glass of orange juice (choice A) right now because he is losing consciousness and therefore cannot eat or drink. The initial treatment for hypoglycemia with both autonomic and neuroglycopenic symptoms is intravenous glucose. This can be discontinued when the patient is able to eat and drink.
Administration of isotonic saline, intravenously (choice C) is part of the initial treatment for diabetic ketoacidosis. 5% glucose solutions should be added when the plasma glucose level falls below 300 mg/dL. This would be inappropriate for a hypoglycemic because they need glucose. The symptoms of DKA include increased urination, thirst, abdominal pain, mental status changes, anorexia, nausea, and vomiting. The patient in this case does not have these symptoms.
Naloxone would reverse this patient's symptoms (choice D) if they were caused by an opioid overdose, not hypoglycemia. Naloxone is an opioid antagonist that competes for the opioid receptors and will block the effects of heroin and other opioids. Symptoms of an opioid overdose include miosis, respiratory depression, coma, hypotension, and bradycardia. The patient in this case does not have these symptoms.
Physostigmine would reverse this patient's symptoms (choice E) if they were caused by anticholinergic poisoning, not hypoglycemia. The symptoms of anticholinergic poisoning can occur with overdoses of antihistamines, atropine, tricyclic antidepressants, and scopolamine, and include hyperthermia, vasodilatation, decreased salivation, mydriasis, delirium, and hallucinations.
The girlfriend did not say that he took any medications. The fact that these symptoms occurred a few hours after a meal and that he has had similar episodes in the past and his physical examination did not reveal mydriasis or hyperthermia makes his condition more consistent with hypoglycemia than anticholinergic poisoning.
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| fox
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what is this dish " fettucine alfredo"? any idea??
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