Hypoglycemia masquerading as acute psychosis in young age

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Introduction

The classic presentation of hypoglycemia includes tachycardia, anxiety, extreme hunger, tremor, palpitations, pallor, weakness and an altered level of consciousness. The hypoglycemic patient's presentation may also lead to suspect another condition such as cerebrovascular accident, seizure, head injury or acute psychosis.

A clinical study was done to determine whether there is a correlation between the manifestations of hypoglycemia and the patient's age.

Methods

We studied 191 prehospital patients in the period from February 1998 to September 1999. For each patient we studied: the level of blood glucose, age and clinical manifestations of hypoglycemia.

Results

99 (51.4%) patients presented with coma, 24 patients (12.6%) presented with focal neurological deficit or seizure activity, 56 (29.2%) were confused and 12 (6.8%) presented as acute psychosis.

We found out that there existed a statistically important difference in patient's age between clinical manifestations of hypoglycemia (Table).

Conclusion

In our study we found out that psychosis as a manifestation of hypoglycemia presents in significantly younger patients than other manifestations (Student t-test <0.05). In elderly patients hypoglycemia presents more often with focal neurological deficit, seizure, confusion and coma. Our cases illustrate the importance of considering hypoglycemia in all patients who present with alterations in mental status even when the clinical findings seem to be explained initially by other etiologies. Emergency physicians must be aware of such a presentation of hypoglycemia and the need for rapid testing, since testing is easily performed and therapy is most often curative with a good outcome.

Table