Hospital Practice
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Seizure in a Polypharmacy Household Luis Fanego, Leon Crumley & Gary W. Edelson To cite this article: Luis Fanego, Leon Crumley & Gary W. Edelson (1992) Seizure in a Polypharmacy Household, Hospital Practice, 27:10, 101-104, DOI: 10.1080/21548331.1992.11705511 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705511
Published online: 17 May 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [La Trobe University]
Date: 31 May 2016, At: 14:23
The Problem Patient
Seizure in a Polypharn1acy Household LUIS FANEGO. LEON CRUMLEY.
and
GARY W EDELSON
Grace Hospital, Detroit
Downloaded by [La Trobe University] at 14:23 31 May 2016
Case Presentation A 77-year-old woman with a history of coronary artery disease, hypertension, congestive heart failure, peptic ulcer disease, Alzheimer's dementia, and mild renal insufficiency was admitted to the hospital after a generalized seizure. According to her husband, she had been doing well at homewithoutanyrecentchange in her multiple chronic problems, until he found her unresponsive. Soon afterward, she was observed to have a tonicclonic seizure, without tongue biting or urinary incontinence. On arrival at the emergency room, the patient's blood glucose was 27 mgldl. She was given two ampules of intravenous 50% dextrose in water, to which she responded. She was not known to be diabetic. Complete neurologic and cardiologic evaluations proved negative, except those indicating dementia. The patient's medications at
At Grace Hospital, Detroit, Dr. Fanego is a Resident in Internal Medicine, Dr. Crumley is Section Chief of General Internal Medicine, and Dr. Edelson is Vice Chief of the Endocrinology and Metabolism Division. Drs. Crumley and Edelson are also Assistant Clinical Professors, Department of Internal Medicine, Wayne State University School of Medicine, Detroit.
the time of admission included isosorbide, triamterene, diltiazem, nitroglycerin, propranolol, and aspirin. Her family history was significant: 1Wo sisters had organic brain syndrome, and her brother and mother had a history of non-insulin-dependent diabetes mellitus. On physical examination. her vital signs were stable and she was afebrile. There was no palpable goiter. appreciable abdominal mass, or signs of infection. An endocrinology consultation was obtained. The differential diagnosis included insulinoma, non-islet-cell tumor, reaction to a drug (e.g., /3-blocker. oral hypoglycemic, aspirin, or insulin) or alcohol, autoimmune adrenal insufficiency, and pituitary insufficiency. An 8:00A.M. cortisol was 19.6 ,ugldl (within the normal range) and TSH was normal at 1.98. Both 24- and 72-hour fasts were ordered. The patient's /3blocker was discontinued, and a urine screen for sulfonylureas was requested. The patient did not become hypoglycemic during either fast; at the conclusion of the 72-hour fast, the proinsulin level was less than 0.4 mg!ml (normal
ISSN: 2154-8331 (Print) 2377-1003 (Online) Journal homepage: http://www.tandfonline.com/loi/ihop20
Seizure in a Polypharmacy Household Luis Fanego, Leon Crumley & Gary W. Edelson To cite this article: Luis Fanego, Leon Crumley & Gary W. Edelson (1992) Seizure in a Polypharmacy Household, Hospital Practice, 27:10, 101-104, DOI: 10.1080/21548331.1992.11705511 To link to this article: http://dx.doi.org/10.1080/21548331.1992.11705511
Published online: 17 May 2016.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ihop20 Download by: [La Trobe University]
Date: 31 May 2016, At: 14:23
The Problem Patient
Seizure in a Polypharn1acy Household LUIS FANEGO. LEON CRUMLEY.
and
GARY W EDELSON
Grace Hospital, Detroit
Downloaded by [La Trobe University] at 14:23 31 May 2016
Case Presentation A 77-year-old woman with a history of coronary artery disease, hypertension, congestive heart failure, peptic ulcer disease, Alzheimer's dementia, and mild renal insufficiency was admitted to the hospital after a generalized seizure. According to her husband, she had been doing well at homewithoutanyrecentchange in her multiple chronic problems, until he found her unresponsive. Soon afterward, she was observed to have a tonicclonic seizure, without tongue biting or urinary incontinence. On arrival at the emergency room, the patient's blood glucose was 27 mgldl. She was given two ampules of intravenous 50% dextrose in water, to which she responded. She was not known to be diabetic. Complete neurologic and cardiologic evaluations proved negative, except those indicating dementia. The patient's medications at
At Grace Hospital, Detroit, Dr. Fanego is a Resident in Internal Medicine, Dr. Crumley is Section Chief of General Internal Medicine, and Dr. Edelson is Vice Chief of the Endocrinology and Metabolism Division. Drs. Crumley and Edelson are also Assistant Clinical Professors, Department of Internal Medicine, Wayne State University School of Medicine, Detroit.
the time of admission included isosorbide, triamterene, diltiazem, nitroglycerin, propranolol, and aspirin. Her family history was significant: 1Wo sisters had organic brain syndrome, and her brother and mother had a history of non-insulin-dependent diabetes mellitus. On physical examination. her vital signs were stable and she was afebrile. There was no palpable goiter. appreciable abdominal mass, or signs of infection. An endocrinology consultation was obtained. The differential diagnosis included insulinoma, non-islet-cell tumor, reaction to a drug (e.g., /3-blocker. oral hypoglycemic, aspirin, or insulin) or alcohol, autoimmune adrenal insufficiency, and pituitary insufficiency. An 8:00A.M. cortisol was 19.6 ,ugldl (within the normal range) and TSH was normal at 1.98. Both 24- and 72-hour fasts were ordered. The patient's /3blocker was discontinued, and a urine screen for sulfonylureas was requested. The patient did not become hypoglycemic during either fast; at the conclusion of the 72-hour fast, the proinsulin level was less than 0.4 mg!ml (normal
