Stress Cardiomyopathy Induced by Refractory Hypoglycemia Due to Acute Sulfonylurea Intoxication

Binoy K Shah; Nicolas F Fiore; Fernando J Fuentes

doi:10.7759/cureus.42279

Stress Cardiomyopathy Induced by Refractory Hypoglycemia Due to Acute Sulfonylurea Intoxication

Cureus. 2023 Jul 21;15(7):e42279. doi: 10.7759/cureus.42279. eCollection 2023 Jul.

Authors

Binoy K Shah¹, Nicolas F Fiore¹, Fernando J Fuentes^{2

3

4}

Affiliations

¹ Internal Medicine, University of Nevada, Reno, Reno, USA.
² Family Medicine, Renown Regional Medical Center, Reno, USA.
³ Internal Medicine/Pulmonary and Critical Care, University of Nevada, Reno School of Medicine, Reno, USA.
⁴ Pulmonology, Renown Health, Reno, USA.

Abstract

Takotsubo cardiomyopathy (TCM) is a reversible syndrome that resembles a myocardial infarction but without typical coronary stenosis and with an apical "ballooning" image present on an echocardiogram. Multiple triggers have been linked to TCM but rarely, acute severe hypoglycemia. This is a case of a 39-year-old woman who was brought to the emergency department after being found unresponsive at home. She was severely hypoglycemic with a glucose of 18 mg/dL and suspected to have sulfonylurea intoxication. The patient was intubated and transferred to our ICU from an outside facility for a higher level of care. The patient was noted to have an elevated troponin and the initial echocardiogram demonstrated TCM. The patient remained persistently hypoglycemic, despite continuous dextrose infusion and glucagon treatment. Stress dose steroids were added with the eventual resolution of hypoglycemia. A repeat echocardiogram demonstrated the resolution of TCM.

Keywords: cardiology; cardiomyopathy; critical care medicine; hypoglycemia; stress induced cardiomyopathy; sulfonylurea; sulfonylurea intoxication; takotsubo cardiomyopathy.

Publication types

Case Reports