62

62 CASE 62


A 54-year-old unresponsive man is brought to the emergency department.


The patient is a business executive and was late for an important meeting. He was found unconscious on his office floor by his assistant. The assistant confirmed that the patient was breathing and then dialed 911. The ambulance crew arrived and provided supportive care, including initiating an intravenous line with lactated Ringers during transport to the local emergency department.



PHYSICAL EXAMINATION



VS: T 36.9°C, P 110/min, R 28/min, BP 90/70 mm Hg, BMI 31

PE: No apparent trauma. The patient is responsive to deep painful stimuli only. There is no medical alert bracelet or necklace.


LABORATORY STUDIES



Glucose (Accu-Chek): 36 mg/dL (normal: 64-128 mg/dL)


DIAGNOSIS


Hypoglycemia



PATHOPHYSIOLOGY OF KEY SYMPTOMS


Loss of consciousness can be related to a number of factors, including delivery of oxygen and glucose to the brain. This patient was found in an environment with adequate oxygen; and if vascular structures are intact, blood pressure should be sufficient to ensure central nervous system blood flow. The low blood glucose level is consistent with the finding of hypoglycemic shock.


Regulation of plasma glucose levels is complex, depending on glucose consumption and storage in a variety of tissues (Fig. 62-1). Pancreatic insulin decreases plasma glucose levels by both promoting storage and tissue utilization.


image

FIGURE 62–1 Plasma glucose levels represent the balance between gastrointestinal glucose absorption, movement into and out of storage pools, and metabolism by mitochondria. Insulin stimulates adipose protein and glycogen synthesis, and the uptake of glucose into skeletal muscle for metabolic use.

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 62

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