Purpose: To present an unusual case of profound postoperative hypoglycemia
resulting in irreversible brain damage in a malnourished patient.
Clinical features. A 56-yr-old malnourished woman underwent laparotomy for
intestinal obstruction under general anesthesia. Five hours postoperatively
she was found to be unresponsive with an immeasureably low blood glucose l
evel, This event was not associated with hyperinsulinemia. Predisposing fac
tors like diabetes mellitus, pheochromocytoma, insulin secreting tumours, a
drenal or pitutary deficiency were absent. She was treated with iv detrose
and hydrocortisone with blood glucose levels stabilizing fairly rapidly. Ho
wever, she unfortunately had sustained irreversible cerebral damage and is
left with significant neurological disability.
Conclusion: Severe postoperative hypoglycemia has several well documented c
auses, Although hypoglycemia does occur to a moderate degree in malnutritio
n, it has not been reported to be so severe as to cause cerebral damage in
the postoperative setting.