Hypoglycemic Coma Due to Insulin Autoimmune Syndrome After Cesarean Section
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 12, Issue 3
Abstract
Hypoglycemia which is often multifactorial is seldom investigated by anesthesiologists in the operating room because it is easy to reverse, but if not addressed in time, the complications associated with hypoglycemia may rarely be fatal, especially in critically ill patients. Insulin autoimmune syndrome (IAS) is an uncommon cause of spontaneous hypoglycemia which characterized by autoantibodies to insulin in individuals, the sulfhydryl group containing agents may be one inducing factor. In this report, we report a hypoglycemic coma due to insulin autoimmune syndrome induced by propylthiouracil occurring in a pregnancy woman with thyrotoxic heart disease and pre-eclampsia during the early postpartum period after cesarean section with intraspinal anesthesia.Hypoglycemia which is often multifactorial is seldom investigated by anesthesiologists in the operating room because it is easy to reverse, but if not addressed in time, the complications associated with hypoglycemia may rarely be fatal, especially in critically ill patients. Insulin autoimmune syndrome (IAS) is an uncommon cause of spontaneous hypoglycemia which characterized by autoantibodies to insulin in individuals, the sulfhydryl group containing agents may be one inducing factor. We report a hypoglycemic coma due to insulin autoimmune syndrome induced by propylthiouracil occurring in a pregnancy woman with thyrotoxic heart disease and pre-eclampsia during the early postpartum period after cesarean section with intraspinal anesthesia.A 21-year-old woman was transferred to our hospital at 25 weeks of gestation with thyrotoxic heart disease (cardiac function in grade Ⅳ), pre-eclampsia, pneumonia, moderate pulmonary hypertension, premature rupture of membranes. On physical examination, she experienced palpitations, anhelation in the sitting position, the heart rate was 130 beats/min and blood pressure were 173/119mmHg. Thyroid function tests showed: free iodothyronine (FT3 27.31pmol/l), free thyroxine (FT4>100.00pmol/l) and thyroid stimulation hormone (TSH <0.005uIU/ml). The echocardiography displayed cardiac enlargement, mild pulmonary hypertension with an estimated pulmonary arterial systolic pressure of 61mmHg. Her medical history was significant for Grave’s disease and no standard treatment before pregnancy. After multidisciplinary consultation, in consideration of the heart failure and premature rupture of membranes one month, it was decided to deliver the fetus urgently. The day before surgery, propylthiouracil 300mg/day were administrated to control the thyroid hyperactivity, intravenous diuretics 20mg/day and cedilanid (Lanasotside C, also known as Isolanid) 0.8mg/day were administrated to promote the heart function. The central venous catheters were inserted in the right internal jugular vein for monitoring the central venous pressure (CVP). In the operating room, the puncture site (L3-4 intervertebral) was identified for employing the combined spinal-epidural anesthesia. when the cerebrospinal fluid was observed, 7.5mg 0.5% hyperbaric bupivacaine was injected into the subarachnoid space slowly and an epidural catheter was placed smoothly. After test dose of 3mL 2 % lidocaine was injected, an additional dose of 5mL 2 % lidocaine was re-injected. In the meantime, a radial arterial line was established under local anesthesia. When the sensory block level rose to T6 the surgery commenced. The procedure lasted 97min and went on uneventfully. The Apgar score of newborns was 5-10-10 at 1, 3, and 5min after birth. When the patient left the operating room, the arterial blood gases analysis showed PH 7.36, PCO2 27mmHg and BE -8.9mmol/l, Glu 6.4mmol/l. In the Post-natal Ward, propylthiouracil 150mg/day and antisterone 20 mg/day were administrated, 120ml of 5% dextrose was given every hour and blood glucose was measured every 4 hours. About 22 hours after surgery, the patient complained of palpitations and sweating followed by unconsciousness.
Authors and Affiliations
Zhiyong Yang, Xueyuan Zhong,, Enqing Wang, Jing He, Bin Yi
Keywords
Related Articles
- EP ID EP592736
- DOI 10.26717/BJSTR.2018.12.002244
- Views 148
- Downloads 0
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