A Patient with Type 1 Diabetes in Whom Hypoglycemia-related Hypothermia Repeatedly Induced Marked Bradycardia

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  • Otani Toshika
    Department of Internal Medicine, Saitama Memorial Hospital Diabetes Center, Tokyo Women's Medical University School of Medicine
  • Kanoh Miki
    Department of Circulation, Saitama Red Cross Hospital
  • Sato Asako
    Diabetes Center, Tokyo Women's Medical University School of Medicine
  • Aoki Atsushi
    Department of Endocrinology and Metabolism, Saitama Medical Center, Jichi Medical University
  • Ikoma Aki
    Department of Endocrinology and Metabolism, Saitama Medical Center, Jichi Medical University
  • Uchigata Yasuko
    Diabetes Center, Tokyo Women's Medical University School of Medicine
  • Otani Yoichi
    Saitama Memorial Hospital

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Other Title
  • 低血糖を契機に低体温から極度の徐脈を繰り返し起こした1型糖尿病の1症例
  • 症例報告 低血糖を契機に低体温から極度の徐脈を繰り返し起こした1型糖尿病の1症例
  • ショウレイ ホウコク テイケットウ オ ケイキ ニ テイタイオン カラ キョクド ノ ジョミャク オ クリカエシ オコシタ 1ガタ トウニョウビョウ ノ 1 ショウレイ

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Description

The patient was a 67-year-old male. At 42 years of age, diabetes was diagnosed. Insulin therapy was started; however, the hyperglycemia persisted. On February 7, 2012, hypoglycemia with cold sweating led to hypothermia, causing disorientation. On February 10, the patient was admitted. It was impossible to measure his body temperature (BT) (lower than 32.0 °C). His heart rate (HR) was 35/min and his blood glucose level (BG) was 90 mg/dl. Electrocardiography showed bradycardia and J waves (V4-6). The administration of BT recovery treatment, intravenous glucose injection and fluid replacement increased the BT and HR to 36.0 °C and 60/min or more, respectively, the following morning. Electrocardiography confirmed the disappearance of J waves. On March 5, the patient was admitted with a consciousness disorder. The BT, HR, and BG were 30.8 °C, 23/min, and 65 mg/dl, respectively. The treatment-related rise in BT was observed, consciousness was regained, and a normal sinus rhythm a returned. On April 11, a consciousness disorder appeared immediately after dinner, and the patient was therefore admitted to our hospital. The BT and HR were 32.8 °C and 26/min, respectively. The coefficient of variation R-R interval was 0.90 %. Due to severe autonomic neuropathy, hypothermia-related hypothermia may have repeatedly induced marked bradycardia.

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