Med. praxi. 2021;18(1):71-74 [Klin Farmakol Farm. 2020;34(3):142-145]

An unexpected cause of delirium

MUDr. Jiří Holý, Ph.D.¹, MUDr. Martin Holý¹, MUDr. Zdeněk Beneš², MUDr. Marie Pešková¹

¹ Interní oddělení Nemocnice České Budějovice, a. s.

² Oddělení úrazové a plastické chirurgie Nemocnice České Budějovice, a. s.

The authors document case history of an 70 years old male patient with hypertension, diabetes mellitus of 2^nd type and dyslipidaemia, after a potentially curative treatment of carcinoma of the prostate gland, suffering from a contusion of right lower extremity followed by a lesion of nervus ischiadicus. The patient took glimepiride 2 mg daily, rosuvastatin 20 mg daily, ramiprilum 5 mg and amlodipine 10 mg in fixed- dose combination and escitalopram 10 mg daily before an admission. The wounded man suffers from the development of rhabdomyolysis with acute renal failure. Repeated delirious status caused by hypoglycaemia appears by the patient during the hospitalisation, for the first time 25 hours after the last dose of glimepiride. These status were treated repeatedly by 40% glucosis as bolus and then continuous intravenous infusion therapy of glucosis, lasted 7 days in general. The patient was also treated by concentrates of erythrocytes, intermittent haemodialysis and antibiotics, he was transfered in a stable status. We explain repeated hypoglycaemia by a cumulation of metabolite of glimepiride owing to acute renal failure. The clinic manifestation of hypoglycaemia was also interesting, it was always delirium with aggression.

Keywords: diabetes mellitus, rhabdomyolysis, acute renal failure, hypoglycaemia, glimepiride.

Published: April 6, 2021  Show citation