title: Severe starvation hypoglycemia and congestive heart failure induced by thyroid crisis, with accidentally induced severe liver dysfunction and disseminated intravascular coagulation.
abstract: A 69-year-old woman caught a cold resulting in nausea, vomiting, diarrhea and severe anorexia. Then she suffered progressively from dyspnea and leg edema, and finally became delirious. On admission severe hypoglycemia, hypothermia, marked tachycardia, generalized edema, mild jaundice and cachexy were noted. EKG showed atrial fibrillation. A chest X-ray, chest CT and echocardiography showed congestive heart failure. Therapeutic use of diuretics induced shock leading to serious liver dysfunction and disseminated intravascular coagulation. However, combined therapy by intravenous glucose, digitalis, diuretics, anti-fibrinolytic drug and hydrocortisone were effective. Addition of antithyroid therapy brought a further favorable outcome.
authors.affiliation: First Department of Internal Medicine, Niigata University School of Medicine, Niigata.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Kobayashi
authors.forename: Hideo
authors.initials: H
authors.lastname: Sasaki
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Kosuge
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyakita
authors.forename: Masahumi
authors.initials: M
authors.lastname: Hayakawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Suzuki
authors.forename: Eri
authors.initials: E
authors.lastname: Abe
authors.forename: Katsunori
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D056486:Chemical and Drug Induced Liver Injury; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000139:chemically induced*; D004232:Diuretics / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000009:adverse effects* / Q000627:therapeutic use; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D007262:Infusions, Intravenous; D008107:Liver Diseases / Q000201:enzymology; D012720:Severity of Illness Index; D013217:Starvation / Q000097:blood / Q000150:complications*; D013958:Thyroid Crisis / Q000097:blood / Q000150:complications*; D013963:Thyroid Hormones / Q000097:blood; D000637:Transaminases / Q000097:blood
chemical_list: D001786:Blood Glucose; D004232:Diuretics; D013963:Thyroid Hormones; D005665:Furosemide; D000637:Transaminases; D005947:Glucose