Hypoglycemia Manifested by Sinus Bradycardia: A Report of Three Cases

Abstract

Three cases are reported of hypoglycemia manifested by profound sinus bradycardia and fatigue, which responded to IV dextrose with prompt normalization of the cardiac rhythm. The cases involved 3 different patients and disease processes: a young female who had anorexia nervosa and profound malnutrition; an elderly, nondiabetic male who subsequently experienced a transient ischemic attack; and a patient who had diabetes mellitus managed with chronic, subcutaneous insulin administration. It is vitally important that the emergency physician recognize unusual clinical manifestations of hypoglycemia and fully evaluate such scenarios when hypoglycemia may occur. Untreated, hypoglycemia may result in significant chronic morbidity, and rarely, in death. Bradyarrhythmias-particularly sinus bradycardia-should be added to the list of potential clinical manifestations of hypoglycemia.

Administration of Recombinant Human Growth Hormone Normalizes GH-IGF1 Axis and Improves Malnutrition-related Disorders in Patients with Anorexia Nervosa

“…The result indicates that glucose metabolism was restored by administration of rhGH. As is suggested, hypoglycemia observed in patients with AN is one of the indicators for the presence of insufficient energy utilization [1,18]. Thus, the treatment with rhGH may rescue the patients from disorder of energy utilization.…”

Fatal neuroglycopaenia after accidental use of a glucose 5% solution in a peripheral arterial cannula flush system

“…The development of sluggish pupils, hypotension and bradycardia was incorrectly ascribed to intracranial haemorrhage. In fact, the latter has been described as an unusual manifestation of hypoglycaemia [21]. As there is now evidence that even mild hyperglycaemia (6.1-8.0 mmol.l ) is associated with increased mortality and morbidity after stroke [3], the possibility exists that hypoglycaemic episodes may be inadequately treated for fear of exacerbating potential ischaemic neurological injury.…”

Hyperinsulinism in a child presenting with cardiac ischemia and bradycardia

“…The association of hypoglycemia with electrocardiographic changes has been well described [1][2][3][4][5][6][7][8][9][10][11][12]. However, most reports describe this association in patients with risk factors or ischemic heart disease, namely diabetes mellitus.…”