Very interesting and unlikely, patient is a end stage renal desease on hemodialysis 3x a week, history of atrial fibrillation and a recent CVA with right upper arm paralysis and right lower extremity hemiparesis. Admitted for pneumonia secondary to aspiration. Pt was NPO since admission. Suddenly developed SVT with HR 190’s. No fever, no signs of pain, K+ level normal, Mg 1.5, BUN/Creatinine elevated but not bad considering patient is in renal failure. Glucose serum an hour ago was 64, no h/o of diabetes. stat CBG down to 53, she was then given 1/2 amp of Dextrose 50%. A dramatic gradual slow down of her HR which is now afib was a surprise but educational. Analyzing the case, pt’s energy reserve has been exhausted due to the recent CVA, has not been eating well and worst was made NPO due to swallowing difficulty and aspiration precaution. That alone had depleted her glucose. My first suspicion was another bout of stroke as patient was awake but aphasic which was baseline on admission.
It is important to note not to forget CBG in any emergency situation. A simple procedure that could save life and any unnecessary diagnostic procedure as well as medications that may worsen the situation.
Again it is proven how our body amazingly communicates when it cannot manifest itself in the normal expected course.