Hypoglycemie bij een geriatrische patiënte met sepsis

Hypoglycaemia in a geriatric patient with sepsis Introduction: This case discusses the atypical clinical presentation of sepsis in a geriatric patient. In this case, hypoglycaemia was the first clinical sign in the absence of other symptoms of sepsis at onset. Case: An 83-year-old woman with no previous history of diabetes mellitus presented to the emergency department with decreased consciousness. The clinical examination revealed a mild hypotension (systolic pressure 95mmHg). Through fingerstick, hypoglycaemia (53 mg/dL) was diagnosed with on laboratory examination an inflammatory blood count (CRP 422 mg/L) and acute renal insufficiency. The next day, haemocultures were positive for Escherichia coli (E. coli) and there was redness of the right hip. Imaging by CT pelvis without contrast showed septic arthritis with destruction of the hip head. Because of possible abscess collections, a hip MRI was performed, which showed abscess collections around the affected hip head into the surrounding muscle tissue (fig. 4). Additional puncture with attempted drainage showed E. Coli after microbiological examination. Because of insufficient drainage, surgical excision of the abscess collections and resection the infected hip head was proceeded. According to the antibiogram, antibiotics were changed to Amoxicillin 1g six times a day with decrease in inflammation and resolution of the hypoglycaemias. The further clinical course was complicated by gastric haemorrhage caused by a stress ulcer with episodes of melena and clinical deterioration of the patient leading to her death. Conclusion: In the geriatric patient without a history of diabetes, hypoglycaemia may be a sign of instituting sepsis. The unfavourable prognosis of sepsis with hypoglycaemia makes it imperative to administer broad-spectrum antibiotics within the first hour.