7493 A Case Report of Recurrent Hypoglycemia With Polysubstance Abuse With Rhabdomyolysis and Capillary Glucose Monitoring Dilemma

Abstract Disclosure: U.D. Gupta: None. P. Prasad: None. P.P. Hlaing: None. K. Panigrahi: None. Z. Deribe: None. Substance use has been correlated with impaired functioning in every bodily system. Over the last two years, our investigations into polysubstance abuse patients have revealed variations in mortality risks, particularly associated with hypoglycemia. We have presented a case of 45-year-old male with a medical history encompassing Bipolar 1 disorder, Polysubstance abuse, and schizoaffective disorder presented to the Emergency Department due to bizarre behavior. On the second day of admission, the patient experienced recurrent hypoglycemia, as indicated by a finger stick blood glucose reading of 39, which was successfully corrected with 50% glucose and D5RL drip. Nevertheless, two hours later, the BG level dropped to less than 20. Despite this, the patient remained asymptomatic and alert, and oral feeding was initiated. However, an ear lobe measurement concurrently indicated a value of 122. The patient's polysubstance use had notable impacts on cardiac, respiratory, metabolic, and renal systems. Blood glucose fluctuations were influenced by both sympathomimetic drug overdoses and underlying disease processes. Instances of hypoglycemia linked to recreational drug use, particularly with substances such as ecstasy, amphetamine, eutylone, and cannabinoids, have been documented. However, there have been a few reports of persistent refractory hypoglycemia in these cases. The probable cause of refractory hypoglycemia is linked to amphetamine and synthetic cannabinoid use, accentuated by compromised elimination due to renal dysfunction. It is noteworthy that the unique recurrent hypoglycemia in our case is evident solely in peripheral finger stick measurements, with no corresponding results in ear lobe or venous blood samples. Healthcare providers may also overestimate the accuracy of portable glucose meter readings. A study revealed widening differences in meter readings (5.7% to 32%)- which needs to be re-evaluated in every instance. Recognizing and understanding cases like this will contribute to improved diagnosis in the future, facilitating the identification of reasons for the observed discrepancy. In addition, as research, papers, and case reports addressing hypoglycemia in polysubstance abuse patients, along with its management and assessment, are notably scarce that need to be addressed with proper assessment of hypoglycemia. It is imperative to conduct thorough assessments and evaluations of such cases to establish a comprehensive management plan, aiming to prevent mortality rather than merely treating symptomatic hypoglycemia. Presentation: 6/3/2024