Streptococcal toxic shock syndrome presenting with spontaneous hypoglycemia in a chronic hemodialysis patient: pathophysiological mechanisms.
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.
Igaki
Naoya
N
Department of Internal Medicine, Takasago Municipal Hospital, Takasago.
Matsuda
Tomokazu
T
Hirota
Yushi
Y
Kawaguchi
Takayuki
T
Tamada
Fumihiko
F
Goto
Takeo
T
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*
D005947:Glucose