Hypoglycemia-induced neurogenic-type pulmonary edema: an underrecognized association.
OBJECTIVE
To report a case of hypoglycemia-induced pulmonary edema and to analyze the underlying pathophysiologic processes.


METHODS
A case report with clinical and laboratory data is presented, and related studies from the medical literature are discussed.


RESULTS
A 23-year-old man with type 1 diabetes was brought to the emergency department because he was found unconscious at home. Despite a morning blood glucose level of 30 mg/dL, he had taken his usual dose of Lente insulin (40 U), and a period of unconsciousness of unknown duration ensued. Intravenous administration of dextrose increased his blood glucose level to 118 mg/dL, but x-ray films of the chest disclosed evidence of pulmonary edema. After 48 hours of supportive care, his respiratory signs and symptoms resolved. The pathophysiologic construct for hypoglycemia-induced pulmonary edema is thought to be the same as for neurogenic pulmonary edema, with a massive sympathetic nervous system discharge being the common denominator in both conditions.


CONCLUSIONS
Clinicians should be aware that severe hypoglycemia can lead to noncardiogenic pulmonary edema as a result of a massive sympathetic nervous system discharge and its associated hemodynamic alterations, in the same manner as occurs in neurogenic pulmonary edema.
Mishriki
Yehia Y
YY
Division of General Internal Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D049528:Insulin, Long-Acting / Q000009:adverse effects*; D008297:Male; D011654:Pulmonary Edema / Q000209:etiology*
D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting