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Hypoglycemia-induced neurogenic-type pulmonary edema: an underrecognized association
1Division of General Internal Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
Objective:
To report a case of hypoglycemia-induced pulmonary edema and to analyze the underlying pathophysiologic processes.
Methods:
A case report with clinical and laboratory data is presented, and related studies from the medical literature are discussed.
Results:
A 23-year-old man with type 1 diabetes was brought to the emergency department because he was found unconscious at home. Despite a morning blood glucose level of 30 mg/dL, he had taken his usual dose of Lente insulin (40 U), and a period of unconsciousness of unknown duration ensued. Intravenous administration of dextrose increased his blood glucose level to 118 mg/dL, but x-ray films of the chest disclosed evidence of pulmonary edema. After 48 hours of supportive care, his respiratory signs and symptoms resolved. The pathophysiologic construct for hypoglycemia-induced pulmonary edema is thought to be the same as for neurogenic pulmonary edema, with a massive sympathetic nervous system discharge being the common denominator in both conditions.
Conclusion:
Clinicians should be aware that severe hypoglycemia can lead to noncardiogenic pulmonary edema as a result of a massive sympathetic nervous system discharge and its associated hemodynamic alterations, in the same manner as occurs in neurogenic pulmonary edema.
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