Three cases are reported of hypoglycemia manifested by profound sinus
bradycardia and fatigue, which responded to IV dextrose with prompt no
rmalization of the cardiac rhythm. The cases involved 3 different pati
ents and disease processes: a young female who had anorexia nervosa an
d profound malnutrition; an elderly, nondiabetic male who subsequently
experienced a transient ischemic attack; and a patient who had diabet
es mellitus managed with chronic, subcutaneous insulin administration.
It is vitally important that the emergency physician recognize unusua
l clinical manifestations-of hypoglycemia and fully evaluate such scen
arios when hypoglycemia may occur. Untreated, hypoglycemia may result
in significant chronic morbidity, and rarely, in death, Bradyarrhythmi
as-particularly sinus bradycardia-should be added to the list of poten
tial clinical manifestations of hypoglycemia.