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Case of steroid-responsive encephalopathy from hypoglycaemia
Jay L Mathur1, Fereshteh Rajabi1, Allison Schroeder2
1Department of Internal Medicine, UPMC Mercy, Pittsburgh, Pennsylvania, USA.
BMJ Case Reports
|August 26, 2017
Summary
Hypoglycaemic encephalopathy, a serious diabetes complication, can occur from insulin errors. This case shows high-dose steroids may rapidly improve neurological function in such patients.
Area of Science:
- Neurology
- Endocrinology
- Metabolic Disorders
Background:
- Hypoglycaemic encephalopathy is a severe complication of diabetes mellitus management.
- It is often associated with insulin therapy, particularly in type 1 diabetes.
- Prompt recognition and management are crucial for patient outcomes.
Observation:
- A 73-year-old woman with type 1 diabetes on an insulin pump became unresponsive after an excessive insulin dose.
- Her neurological status showed little improvement over eight days.
- This suggested a severe hypoglycaemic insult to the brain.
Findings:
- Intravenous administration of 1g methylprednisolone was initiated.
- The patient experienced a dramatic improvement in neurological function.
- This included successful extubation and discharge from intensive care.
Implications:
- This case highlights a potential novel treatment for hypoglycaemic encephalopathy.
- Steroid responsiveness in encephalopathy is increasingly recognized.
- This is the first reported instance of hypoglycaemic encephalopathy responding to high-dose corticosteroids.
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