AB274. SOH26AB_0129. An obscure cause of hypoglycaemia in intensive care: a case report

Background: Causes of intensive care unit (ICU) hypoglycaemia can be challenging to determine.

Case Description: A 76-year-old male was admitted to the hospital with shortness of breath, new oxygen requirements, and productive cough. His past medical history was positive for chronic obstructive pulmonary disease (COPD), high cholesterol, and poliomyelitis affecting his right leg. There was widespread wheeze on auscultation of the chest, and there were no distinct areas of opacification in his chest X-ray. The next day, the patient’s condition worsened, and he was intubated and admitted in the ICU for severe bronchospasm. His treatment was escalated to aminophylline and salbutamol infusions, which continued for 1 and 3 days, respectively. Initially, the patient became hyperglycaemic and was started on intravenous insulin infusion. Two days after the salbutamol infusion was stopped, the patient experienced multiple episodes of hypoglycaemia during the day despite the insulin infusion being stopped since the morning hours and the patient being on enteral feed and steroid therapy. While both aminophylline and salbutamol can cause initial hyperglycemia by stimulating glycogenolysis in muscle and liver, hypoglycaemia is likely a delayed effect of high doses of salbutamol administered both parenterally and through nebulization. Hyperglycaemia can lead to a compensatory hyperinsulinemic response, which can result in hypoglycaemia becoming evident many hours after medication administration. Hypoglycaemia can also result from glycogenolysis and depletion of glycogen reserves.

Conclusions: High doses of B-sympathomimetics can lead to alteration of plasma glucose levels, and long-term monitoring may be required until euglycaemia is established.

Keywords: Bronchospasm; hypoglycaemia; insulin; salbutamol; case report