UDK  616.37-008.61-079       

ISSN 2466-2992 (Online) (2017) br.1-2, p. 8-12

        616.379-008.64-06

COBISS.SR-ID 36357129                   



DIAGNOSTIC DILEMMAS IN A PATIENT WITH A CONSCIOUSNESS

DISORDER - A CASE REPORT


Radica Krstić, Biljana Radisavljević, Snežana Mitrović, Tatjana Mićić, Ivana Ilić, Goran Živković

Emergency Medicine Service, Niš, Serbia



Summary:


INTRODUCTION: Hypoglycemic coma is the most common acute complication of diabetes mellitus, which emergency physicians encounter in the field often. After substitution therapy, there is usually a complete recovery of consciousness.


AIM: By presenting the case, we wanted to point out the importance of a careful approach to a patient who has a disorder of consciousness, hypoglycemia, and when a hypertonic solution with glucose does not lead to complete recovery.


MATERIALS AND METHODS: The protocol of the field intervention, the medical documentation of the Emergency medical service, the discharge document of the Clinic for Neurology of the Clinical Center Nis.


CASE REPORT: The paper presents a sixty-one-year-old patient suffering from diabetes mellitus in a coma with hypoglycemia whose complete recovery does not occur after the application of hypertonic glucose solution and return to normal blood glycemic levels. Changes in the quality of consciousness and deterioration in a short period led the doctor think that there is more serious damage with long-term hypoglycemia of brain cells, electrolyte and acid-base disorder, or that it is some other cause of worsening consciousness in the patient. The patient was hospitalized and subarachnoid hemorrhage was diagnosed.


DISCUSSION: Patients with consciousness disorder rarely, but can still have two different etiopathogenetic factors at the same time as in the case of our patient where the picture of subarachnoid hemorrhage is masked with the clinical picture of hypoglycemic coma. Emergency medicine specialist during the clinical assessment of the patient's condition need to think widely which is different from other specialties that usually consider only conditions in their domain. Assessment and differential diagnosis in admission triage wards and in prehospital conditions is a great challenge and requires great knowledge and experience of every doctor who deals with emergency medicine.


CONCLUSION: Making a working diagnosis in prehospital conditions is based on good anamnestic data and clinical examination with help of limited diagnostic methods. The emergency physician must make multiple work diagnoses and suspect any pathological conditions that may present a similar clinical picture.


Key words: hypoglycemia, coma, subarachnoid hemorrhage, disturbance of consciousness.



Korespondencija/Correspondence


Dr Radica KRSTIĆ

Zavod za hitnu medicinsku pomoć

ul. Vojislava Ilića bb

18000 Niš

e-mail: radica_krstic@yahoo.com

Issue 2017-1/2 / article 1

SRP / ENG

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