Sd. Luber et al., ACUTE HYPOGLYCEMIA MASQUERADING AS HEAD TRAUMA - A REPORT OF 4 CASES, The American journal of emergency medicine, 14(6), 1996, pp. 543-547
Hypoglycemia, a commonly encountered metabolic emergency, is most ofte
n easily diagnosed and rapidly treated with satisfactory patient outco
me, If not recognized and treated promptly, hypoglycemia may cause irr
eversible central nervous system injury; it rarely results in death, T
he classic presentation of hypoglycemia, a patient with diabetes melli
tus on medical therapy (insulin or oral hypoglycemic agents) who prese
nts with an altered sensorium, is frequently seen in the emergency dep
artment (ED), Less often, patients with this metabolic emergency prese
nt to the ED in a manner suggestive of a situation other than hypoglyc
emia, Patients may present with seizure activity or focal neuro logica
l deficits, leading the physician to treat a primary neurological synd
rome and not immediately recognize the primary cause of the problem, A
lternatively, patients with hypoglycemia will present to the ED with a
n altered mental status after a traumatic event, The physician may aga
in assume that the alteration in consciousness has resulted from a hea
d injury and not a metabolic disorder, Four cases are presented in whi
ch the medical history of the event (ie, trauma) suggested head injury
as an explanation of the presentation when, in fact, hypoglycemia was
responsible for the altered sensorium, The diagnosis of hypoglycemia
is easily made with the performance of a bedside screening test which
can be subsequently confirmed by laboratory blood analysis, It is impe
rative that emergency physicians consider hypoglycemia in all patients
with any mental status abnormality, focal neurological deficit, or se
izure activity, even when the findings seem to be explained initially
by other etiologies. Copyright (C) 1996 by W.B. Saunders Company