[14,18,24,25] The importance of strict glucose monitoring should be emphasised to medical staff, particularly in intubated patients, to avoid unrecognised neuroglycopenia
Long periods without meals may lead to neuroglycopenia
[low glucose levels in brain] and compromise mental function in children.
Hypoglycemia can be classified into two groups: one that arises from the action of the autonomic nervous system and one that is related to an insufficient supply of glucose to the brain (neuroglycopenia
Clinical symptoms of cerebral malaria mimic diabetic ketoacidosis and severe neuroglycopenia
. Absence of fever, and relative bradycardia, may confuse the emergency physician.
We present a case of sporadic insulinoma in a yo ung, 24-year-old female patient, who presented witl a 2-month history of episodic shaking, diaphoresis increased hunger, confusion, obtundation and fainting Symptoms of neuroglycopenia
were predominant, sc the family members reported that the patient has un dergone a personality change.
It is not clear if the brain is able to adapt to restricted glucose availability during extended periods and prevent neuroglycopenia
or if cerebral damage due to oxidation of brain lipids will develop over time.
A 50 g/L dextrose infusion was started to counter possible neuroglycopenia
(which was presumed to be contributing to the decreased level of consciousness), and Nephrology and Critical Care were consulted for urgent hemodialysis.
Diagnosis of insulinoma is often delayed in this group of patients because neuropsychiatric signs and symptoms such as confusion, personality change, ataxia, and seizure that occur following hypersecretion of insulin by this tumor and consequent hypoglycemia and neuroglycopenia
are commonly seen in a variety of other pediatrics diseases [1,2].
Besides the autonomic symptoms, there may also be symptoms linked to the lack of glucose in the brain (neuroglycopenia
): vertigo, confusion, exhaustion, weakness, headaches, inappropriate behavior, which may be confused with drunkenness, lack of attention, vision abnormalities, convulsions similar to epilepsy, and coma .
Patients with insulinoma have symptoms of hypoglycemia resulting from neuroglycopenia
and increased catecholamine release.
In addition, a growing number of Roux-en-Y patients are showing neuroglycopenia
and diabetes recurrence several years after surgery, which is concerning.
"There may be other issues that are neurological, such as whether neuroglycopenia
from repeat hypoglycemia is having some kind of effect."