#001 Curveball Case Study - Hypoglycaemic seizure

FY2 doctor ATSP overnight re: seizures

40M admitted for chest infection

IVDU

Right leg amputation secondary to infection (IVDU)

Previous MI

Co-amoxiclav

Enoxaparin

NKDA

NB Not compliant with regular medications

Homeless, smoker, current heroin user, drinks 20 units/day

A – Patent

B – Sats 96% on 10L, B/L expansion and air entry. Mild creps right base

C – HR 98, BP 127/60, HS I+II+0, JVP down, CRT 2s

D – Seizures – fine myoclonic. GCS 3 E1, V1, M1. PEARL

E – Temp 35.6C. Abdo SNT

CXR – patchy consolidation

ECG – sinus rhythm

Bloods – WCC 15, Hb 105, U+E NAD

Reviewed patient with nurse unsure of diagnosis:

DDx – ?Intracerebral bleed

Plan – CT head

Nurse then performed blood glucose = 1.2

Given dextrose → consciousness improved to GCS 10

CT head NAD

Learning point – Could have acted faster if I’d done glucose as part of disability on A-E

NB For a review of seizure management, have a look at our Acute Neuro/Psych resource here