Case Presentation: A 44-year-old male presented to the emergency department with a 2 hour history of altered mental status. His wife reports that when he awoke, he was confused and acting inappropriately. After no improvement for 2 hours he was brought to the ED. En route to the ED, he ate a Hershey chocolate bar [...]

Case Presentation: A 65-year-old woman was admitted to our hospital because of episodes of altered mental status and high blood pressure. Forty days prior to admission, the patient was taken to the emergency department with an altered mental status and hypertension. Her blood pressure was 226/129 mmHg, while her blood glucose level was 48 mg/dL. [...]

Case Presentation: A 65 year old woman with hypertension, hyperlipidemia, and gastric bypass surgery in 2005 presented to the emergency department with episodes of confusion. Four years prior to her presentation she began to have episodes of confusion where she would stare off into space and it was noted that eating relieved these symptoms. She [...]

Case Presentation: Insulinoma is a rare tumor that originates in the beta cells of the pancreas with an incidence of 1-4 cases/million persons/year. Less than 10% of insulinomas are malignant and represent a treatment challenge despite the development of new therapeutic approaches in the last decade. A 28 year old female with no past medical [...]

Case Presentation: A 40-year-old female with a history of morbid obesity status post Roux-en-Y gastric bypass in 2009 presented to hospital with blood glucose level of 33. She reported hypoglycemic episodes every day since 2007 with prior labs demonstrating elevated insulin and low c-peptide levels. The differential diagnoses included exogenous administration of insulin, given she [...]

Case Presentation: A 63-year-old female with a history of heart failure with reduced ejection fraction and pre-diabetes presented to the hospital with lower extremity weakness. On presentation, her physical exam was significant for bilateral lower extremity pitting edema and hepatomegaly. Lab work showed an elevated total bilirubin (7.3mg/dL) and direct bilirubin (3.8mg/dL), liver function tests [...]

Case Presentation: An 80-year-old female with dementia presented with 4 months of intermittent confusion, hypoglycemia, and associated generalized weakness. Her symptoms resolved with eating. She had no diabetic medications at home. She was hospitalized 1 month prior for these symptoms; her blood glucose during that admission was 39 mg/dL, C-peptide was 6.9 ng/mL (reference range [...]

Case Presentation: A 27-year-old male brought to the emergency department after being found unresponsive on the floor. The patient had no recollection of subsequent events until awakening in the ambulance. Notably, he had two prior hospitalizations for episodes of amnesia, “being off” and visual hallucinations. The patient was found to be hypoglycemic by the paramedics [...]

Case Presentation: A previously healthy 17-year-old girl was brought to the emergency department (ED) by ambulance following a generalized tonic-clonic seizure. Her blood glucose was 61 mg/dL at the scene and 31 mg/dL on arrival to the ED. A basic metabolic panel was obtained and was within normal limits with the exception of low plasma [...]