Unsuccessful cardiopulmonary resuscitation in a 46-year old woman with malignant disease and severe refractory hypoglycaemia

Introduction: Severe hypoglycaemia carries high short-term mortality. When associated with malignancy, it is interestingly highly dependent on increased glucose consumption due to glycolytic metabolism preference. There is no general consensus on the therapy in end-stage malignant disease.

Case report: A 46-year old female with a recently diagnosed Hodgkin lymphoma presented in September 2019 to the emergency department with weakness, chills and fever. Apart from the diffuse lung interstitial syndrome, sinus tachycardia and respiratory collapsing inferior vena cava, her vital signs and physical examination revealed no significant abnormalities. Hypoglycaemia was determined/detected in the laboratory findings. During the secondary assessment, she arrested and cardiopulmonary resuscitation was initiated. Peripheral glucose measurements showed that refractory hypoglycaemia was unresponsive to any glucose infusions. After the return of spontaneous circulation, laboratory findings revealed severe hyperglycaemia. Soon after, the patient arrested again and a decision was made to apply Intralipid emulsion. CPR ended unsuccessfully.

Conclusion: Septic shock with clinical markers of peripheral malperfusion can cause falsely low or immeasurable glucose levels in peripheral capillary blood.

Hypoglycaemia; Malignancy-associated hypoglycaemia; Peripheral vasoconstriction; Cardiopulmonary resuscitation; Shock

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