Sat27November0556PM 10

An 88-year-old lady from a nursing home presents with repeated episodes of symptomatic hypoglycaemia. Despite initial treatment with glucagon from the paramedics the blood sugar keeps dropping to below 2 mmol/L.

Past medical history includes type 2 diabetes, hypertension, recurrent urinary tract infections (UTI), and vascular dementia. Medications include amlodipine 5 mg, irbesartan 150 mg OD, ramipril 5 mg OD (recently added), gliclazide 160 mg BD (recent dose increase), nitrofurantoin low dose and recent treatment with gentamicin for UTI.

Which of the following is the correct mode of managing the underlying problem and so the hypoglycaemia?

(Please select 1 option)

Intravenous antibiotics

Aggressive fluid management

Intravenous hydrocortisone Incorrect answer selected

Intravenous infusion 10% dextrose This is the correct answer

Haemodialysis

Explanation

This is an elderly patient with a number of nephrotoxic drugs and likely scarred kidneys secondary to multiple UTIs. She has also had her dose of gliclazide increased in the recent past and some gentamicin. The entire sequence of events has resulted in acute renal impairment and so accumulation of gliclazide.

The clue is the fact that the patient is failing to respond to glucagon. Treatment will require an infusion of dextrose over a 24 hour period with glucose monitoring, until the gliclazide has been eliminated from the system. Alongside this, stopping the sulphonylurea and the other nephrotoxic drugs and gentle intravenous rehydration is also required.

Haemodialysis will not be beneficial in this case as the gliclazide binds too firmly to proteins.

Answer Statistics

1

5%

2

5%

3

15%

4

58%

5

18%

Times answered: 325