title: Streptococcal toxic shock syndrome presenting with spontaneous hypoglycemia in a chronic hemodialysis patient: pathophysiological mechanisms.
abstract: Hypoglycemia is fatal if associated with sepsis in end-stage renal disease (ESRD) patients. We report a hemodialysis patient of streptococcal toxic shock syndrome presenting with hypoglycemia. She was found to be severely hypoglycemic with a plasma glucose level of 16 mg/dl. Immunoreactive insulin levels were undetectable throughout the clinical course. Several factors including reduced renal gluconeogenesis, reduced hepatic glucose output and excessive peripheral glucose utilization may account for the hypoglycemia in this patient. In conclusion, we would like to draw attention to the fact that septic ESRD patients without diabetes are prone to develop profound hypoglycemia with serious consequences.
authors.affiliation: Department of Internal Medicine, Takasago Municipal Hospital, Takasago.
authors.forename: Naoya
authors.initials: N
authors.lastname: Igaki
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Matsuda
authors.forename: Yushi
authors.initials: Y
authors.lastname: Hirota
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Tamada
authors.forename: Takeo
authors.initials: T
authors.lastname: Goto
mesh_terms: D000368:Aged; D017809:Fatal Outcome; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology / Q000378:metabolism*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D006435:Renal Dialysis; D012772:Shock, Septic / Q000378:metabolism* / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications*
chemical_list: D005947:Glucose