Severe starvation hypoglycemia and congestive heart failure induced by thyroid crisis, with accidentally induced severe liver dysfunction and disseminated intravascular coagulation.
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.
Kobayashi
Chiaki
C
First Department of Internal Medicine, Niigata University School of Medicine, Niigata.
Sasaki
Hideo
H
Kosuge
Keiichiro
K
Miyakita
Yasushi
Y
Hayakawa
Masahumi
M
Suzuki
Akiko
A
Abe
Eri
E
Suzuki
Katsunori
K
Aizawa
Yoshifusa
Y
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
D001786:Blood Glucose; D004232:Diuretics; D013963:Thyroid Hormones; D005665:Furosemide; D000637:Transaminases; D005947:Glucose