title: [Bilateral fractures of the humerus after hypoglycemic seizure].
abstract: METHODS
  An 87 year-old woman with insulin dependent diabetes was referred to our hospital because she had sustained a generalized tonic-clonic seizure. Initial blood sugar concentration before hospital admission was 1.1 mmol/l.
  
  
  METHODS
  Conventional radiography and computed tomography of both shoulders confirmed the diagnosis of bilateral proximal fractures of the humerus with posterior dislocation. The cause of the seizure was found to be iatrogenic because timing of application of the dual-acting insulin medication had been wrongly changed, and the patient had developed severe hypoglycemia.
  
  
  METHODS
  After administration of glucose and a 7-day course of antibiotics for aspiration pneumonia, both fractures were treated surgically with hemiarthroplasty. After a four-week stay in hospital the patient was discharged to her nursing home, requiring much more care than before.
  
  
  CONCLUSIONS
  The presentation of simultaneous bilateral fractures of the humerus is a rare but severe and almost pathognomonic complications of generalized tonic-clonic seizures, for example in the context of marked hypoglycemia. Appropriate monitoring and treatment of blood sugar levels in diabetics must be emphasized.
authors.affiliation: Medizinische Klinik, Spital Zollikerberg, Zollikerberg, Zürich, Schweiz.
authors.forename: N
authors.initials: N
authors.lastname: Lambrinoudakis
authors.forename: M C
authors.initials: MC
authors.lastname: Glanzmann
authors.forename: D
authors.initials: D
authors.lastname: Franzen
mesh_terms: D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000150:complications*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007049:Iatrogenic Disease; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D008508:Medication Errors / Q000009:adverse effects; D012640:Seizures / Q000150:complications* / Q000209:etiology; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000209:etiology; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin