A 78-year-old woman, self-valent, independent in activities of daily living, with complete education, has a history of hypertension, hypothyroidism, hearing loss and type 2 diabetes mellitus (DM 2) managed with adequate capillary glibenclamide 1,700 mg and metaformin.
The patient was taken by family members to the Emergency Department for evaluation due to qualitative compromise of consciousness, non-fluctuating, of more than 24 hrs of evolution, without signs of focalization and with complete spontaneous recovery.
His family noted the increasingly frequent occurrence of similar episodes in the last 2 months, also indicating changes in recent memory, behavior and self-limiting gait changes, without partial loss of sphincter function.
Vigilance, spatially oriented, cognitive impairment expected, hemodynamically stable, whose score obtained (with no award and a neurological examination in which only an abnormal performance was highlighted 22 points in the Minije questionnaire)
Blood glucose, creatinine, natraemia, calcemia, TSH, vitamin B12 levels and complete blood count were normal.
There was no elevation of diagnostic parameters, HIV-negative ELISA and non-reactive RPR.
An unenhanced axial computed tomography of the brain was performed, which investigated a hemorrhagic lacunar infarction left putaminal, probably old.
The electroencephalogram showed generalized intermittent slowness.
Doppler ultrasound showed carotid atheromatosis right carotid without hemodynamic compromise.
Having these findings made it possible to explain the clinical picture.
The patient was managed with a diabetic diet without oral hypoglycemic agents, progressing asymptomatically and with blood glucose levels within the appropriate range.
The glycosylated hemoglobin A1C was 5.2%, which made us suspect the possibility of recurrent episodes of hypoglycemia.
Therefore, it was decided to discontinue glibenclamide and decrease the metformin dose prior to discharge.
In outpatient controls, two and six months after discharge, the patient was vigilant, spatially oriented, well oriented to medium, achieving 26 points in Mini Mental on both occasions.
His family did not restrain new episodes of altered consciousness or behavior, interpreting the original picture as secondary to frequent subclinical hypoglycemia.
