A case of my clinic
(19)
Yesterday, in my climic I had seen a (41) year male Pt that referred to me from one of our collegues! The pt present with frequent attack of slurred speach and dizziness and tachy cardia with pallor and sweating during the attack. He denied any past hx of chronic disease and he said that just last year he went to iran and they do every invistigation (general investigation = lie term) and even (OGD) had been done gor him and they told him that he had white outfits looking sexy and sassy ... gastritis. In his past hx he also mention that he had RTA before two years and he remainef in Casuality Departrment just for two hours and he said that during the attach he will check RBS and result will be (60 mg/dl) and sometime may be lower.
Approach:
1. In case of hypoglycaemia its a must that you should know its acute (hypoglycaemia, poisoning, uraemia, epilepsy, stroke, ICH, meningitis, head injury) and wether its recurrent (epilepsy, arrythmias, psychiatric disorder, phaeochromocytoma).
2. Ix: For all cases: do RBS
A. DM: approach is clear review medicine.
B. No DM:
1. For recurrent or unexplained episodes; ask for plasma insulin and C-peptide + RFT + LFT + insulib Ab test + thyroid and adrenal function test.
2. For suspected insulinoma: do FBS + insulin + C-peptide + CT .
3. For non insulinoma, Non - DM related hypoglycaemia: 09:00 h cortisol and Synacthen test, growth hormone profile, insulin like growth factor analysis, LFT.