Hypoglycemic noncardiogenic pulmonary edema: a case report

Hypoglycemic pulmonary edema was well addressed in the mid-1900s, and experimental data in addition to clinical reports have confirmed the association. The pathophysiology is similar to a neurogenic type of noncardiogenic pulmonary edema. Despite this, medical textbooks have not included hypoglycemia as a possible cause of this type of pulmonary edema, and only a few case reports are published, meaning that this association is often forgotten. To the best of our knowledge, our case is the first case report in over 15 years.

A 55-year-old Eritrean male patient with known diabetes presented to our emergency room after he became unconscious at home. He was accompanied by his family. On examination, his random blood sugar was measured at 58 mg/dL, and he had a Glasgow Coma Scale score of 9/15. He was severely hypoxic, with bilateral crackles. Upon management of hypoglycemia with dextrose infusion, he improved steadily with supportive oxygen until his Glasgow Coma Scale score reached 15/15, when his pulmonary edema showed marked improvement. He was discharged, with his condition improved, on third day of admission.

The unique presentation of pulmonary edema in a 55-year-old patient with diabetes underscores the possibility of hypoglycemia causing noncardiogenic pulmonary edema. This case contributes to the understanding of atypical complications of hypoglycemic neurologic insult.