ACUTE HYPOGLYCEMIA MASQUERADING AS HEAD TRAUMA - A REPORT OF 4 CASES

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