Suspecting unwitnessed hypoglycaemia

Hypoglycaemic coma can present with acute neurological dysfunction mimicking stroke. It may be masked by normoglycaemia due to physiological compensatory mechanisms (Somogyi phenomenon). Specific MR brain scan changes should alert the clinician to consider this alternative to stroke in the acute setting in patients with a history of recurrent hypoglycaemia, even when the blood glucose is not low at presentation. Rapid identification and treatment of hypoglycaemia may confer a good prognosis with radiological resolution.

Diabetes and endocrine emergencies

This chapter describes diabetes and endocrine emergencies, including diabetic ketoacidosis (DKA; assessment, management, complications), hyperosmolar non-ketotic coma (HONK), hypoglycaemic coma, urgent surgery in patients with diabetes, diabetic foot complications, hyponatraemia, hypernatraemia, acute hypocalcaemia, hypercalcaemia, hypophosphataemia, Addisonian crisis, myxoedema coma, thyrotoxic crisis, pituitary apoplexy, hypopituitary coma, phaeochromocytomas, polyuria, malignant hyperthermia, and neuroleptic malignant syndrome.

Clinical Presentation Of The Abuse Of Insulin: Hypoglycaemic Coma And Aspiration Pneumonia In Non-Professional Bodybuilders

The use of medications that improve the physical performance of an individual represents a very serious worldwide health problem. The abuse of these medications is increasing. Herein, we describe a patient, at the age of 20, who was hospitalized due to loss of consciousness and difficulty breathing. At admission, the patient was unconsciousness, tahi-dyspnoic, and had a pale complexion and an athletic build. In gas analyses, extremely low saturation was observed, followed by acidosis, heavy hypoxia with normocapnia, higher lactates, hypocalcaemia and severe hypoglycaemia. The patient was treated with a hypertonic solution of glucose and intubated, with the aspiration of sanious content from the respiratory tract. After treatment, the patient woke from coma but was very confused. In the first 6 hours of hospitalization, severe hypoglycaemia occurred several times, despite the continuous administration of glucose. Due to the growth of inflammatory syndrome since the first day of hospitalization, the patient was kept in the hospital for treatment along with the administration of antibiotic treatment. On the fourth day of hospitalization, the patient stated that for the last year, he had been taking testosterone at a dose of 1 g a week, as well as tamoxifen pills and 15 i.j. of fast-acting human insulin (Actrapid®) daily for their combined anabolic effect. Hypoglycaemic coma, caused by the abuse of insulin, represents a severe complication in patients, which can be followed by confusion, a slowed thinking process, the weakening of cognitive functions and even death. It is necessary to invest great efforts into the prevention of the purchase of these medications via the Internet or on the black market for purposes of abuse in order to prevent such serious and life-threatening complications.

The works of professor N.P. Kravkov in the area of endocrinology

This article describes the academic works of the N.P. Kravkov (1865–1924), a prominent Russian pharmacologist, on the study of the endocrine glands.In N.P. Kravkov’s laboratory, via experiments on rabbits and dogs, a method of isolating the pancreas and extracting its perfusate was developed based on passing Ringer-Locke’s solution through the vessels of the isolated gland. It was discovered that the perfusate contains a substance that reduces the level of glucose in the blood of healthy animals and, in large doses, causes hypoglycaemic coma. N.P. Kravkov called this substance pancreotoxin.The experiments of N.P. Kravkov’s followers on the isolated hearts of animals showed that, for a heart in the normal condition, pancreotoxin decelerates the heartbeat and reduces the amplitude of contractions, whereas for the heart tired above a certain threshold, the opposite effect is observed.The study of the blood vessels in isolated ears of rabbits and the eyes of frogs revealed antagonism between pancreotoxin and adrenalin: pancreotoxin weakens the vasoconstrictive effect of adrenalin and reduces its influence on the size of the pupil in frogs. It was also shown that passing the perfusate containing pancreotoxin through the adrenal gland increases the secretion of adrenalin.Later, pancreotoxin was obtained in the dried form and used to prepare a drug prescribed to patients with diabetes in hospitals.From its properties, pancreotoxin turned out to be insulin. It should be noted that the news that insulin had been isolated from the pancreas by the Canadian researchers F. Banting and C. Best reached Russia only after the researchers in N.P. Kravkov’s laboratory had extracted and studied pancreotoxin from isolated pancreases. Thus, N.P. Kravkov and foreign researchers discovered this hormone independently.In experiments on the isolated adrenal glands of cattle, N.P. Kravkov and his collaborators obtained the perfusate containing an adrenalin-like substance produced in the medulla of the adrenal gland and a muscarine-like substance produced by the suprarenal cortex.The research by N.P. Kravkov and his followers on the physiology, pathology and pharmacology of the glands of internal secretion at the beginning of the 20th century has proved to be of great importance for the development of endocrinology in Russia.

Endocrine emergencies

Diabetic ketoacidosis (DKA): assessment 516 DKA: management 1 518 DKA: management 2 520 DKA: complications 522 Hyperosmolar non-ketotic coma (HONK) 1 524 HONK 2 526 Hypoglycaemic coma: assessment 528 Hypoglycaemic coma: management 530 Urgent surgery in patients with diabetes 532 Hyponatraemia: assessment 534 Hyponatraemia: causes ...