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Case Study: A 90-Year-Old Man With Confusion and Night Sweats

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	Presentation

 
C.G. is a 90-year-old man with metastatic prostate cancer who was brought to the emergency room (ER) at midnight after being found confused and sweaty. In the ER, his blood glucose level was 44 mg/dl. He received one ampule of D50 and was started on intravenous D5NS. His confusion improved.

On transfer to the medical floor, his blood glucose level was 161 mg/dl. He denied nausea, vomiting, abdominal pain, diarrhea, constipation, chest pain, shortness of breath, palpitations, and weight loss. His last meal had been at 6:00 p.m. He recalled another episode of confusion 3 weeks ago in the middle of the night that was milder and did not require hospitalization.

His medical records revealed that his blood glucose levels had been elevated in 1996 (136–144 mg/dl) and that 1 month before admission, his blood glucose level was 50 mg/dl.

His medical history was remarkable for prostate cancer on leuprolide (Lupron) injection, colon cancer (status post hemi-colectomy) with recent negative colonoscopy, idiopathic thrombocytopenic purpura requiring splenectomy, and vitamin B12 deficiency. He did not smoke or drink alcohol and he had no allergies.

He took leuprolide via intramuscular injection every 3 months; vitamin B12, 1,000 mg via intramuscular injection monthly; and aspirin, 325 mg per day orally. There was no personal or family history of diabetes, occupation in an allied health profession, or past insulin treatment.

Physical examination showed a well-nourished man in no acute distress. He was alert and awake. His blood pressure was 120/80 mmHg, heart rate was 66 and regular, . . . [Full Text of this Article]

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