Tehran University Medical Journal

Background: Hypoglycemia is a condition when blood glucose level is lower than 70 mg/dl in people without diabetes. The symptoms of hypoglycemia include tachycardia, sweating, pallor, pupillary dilatation. Hypoglycemia is a non-lethal and often preventable clinical problem in non-diabetic patients that can occur during fasting or after dining.
Case presentation: A 52 years old man referred to Shohada-e-Tajrish Hospital, Tehran, with diagnosis of kidney stones candidate for percutaneous nephrolithotomy (PCNL). The patient underwent general anesthesia and after 40 minutes, the surgeon requested injection of tranexamic acid because of bleeding, but unintentionally the patient received 100 unites of crystalline insulin by nurse anesthesia. Vital signs were stable, the patient's blood glucose was 85 mg/dl and he had no sweat. Then the therapeutic intervention consisted of administering a bolus dose of 50 cc 50% dextrose water (DW) and then infusion of 50% dextrose water over that time. The patient was monitored for 10 hours in recovery and also received 1 mg of glucagon. The blood glucose was checked frequently. Fortunately, there were not any detectable hypoglycemic attacks (blood glucose less than 70 mg/dl) during that time. Throughout the first three hours in ICU, he suffered from severe hypoglycemic episodes and treated by DW 50% (bolus stat and infusion) and after stabilization of vital signs he transferred to ward.
Conclusion: The mortality of iatrogenic hypoglycemia is lower than other causes of hypoglycemia. However, on time diagnosis and aggressive treatment can prevent serious complications. In addition, proper communication between health care providers and precise checking of drugs labels before injection can dramatically decrease these events.

Background: Hypoglycemia can cause permanent damage to the brain or lead to death. That is why it is very important to prevent or quickly correct hypoglycemia to save life for the treatment of hypoglycemia following the use of Sulfonylureas, taking oral nutrition for the patient or administration of injectable hypertonic glucose is recommanded. But recurrence and resistance to treatment are common in sulfonylurea poisoning. Due to the vulnerability of the brain to long-term hypoglycemia, plasma glucose concentrations should be returned to normal as soon as possible and recurrences of hypoglycemic attacks should be prevented. Because Octreotide is of particular importance in the control of hypoglycemia, this study aimed to use Octreotide to treat recurrent and refractory hypoglycemia due to Glibenclamide use.
Case presentation: In this study, four patients with an average age of 30.75 years and an age range of 18-40 years were evaluated and managed. Following suicide with a high dose of Glibenclamide, they had refractory hypoglycemic attacks So for these patients, Octreotide was started at a dose of 50 μg every 6 hours, and all of them responded to Octreotide therapy, and the hypoglycemic attacks were greatly reduced. All patients were treated with Dextrose 50% at the time of admission. However, their blood glucose dropped significantly and did not respond to the dextrose diet. However, receiving the first dose of Octreotide with a significant increase in patients' blood glucose showed a favorable effect of Octreotide in this study.