Alcohol-related hypoglycemia in rural Uganda: socioeconomic and physiologic contrasts

A 32-year-old man was found confused and moaning in bed by family at 5 a.m., and brought in by family at 9 a.m. Family members stated he had eaten lunch and dinner with them the previous day, then went out drinking alcohol with friends and came home at 3 a.m. Past medical and surgical histories were unremarkable, and he takes no medications and has no allergies.On examination, his vital signs were stable (blood pressure 110/70 mmHg, heart rate 68 bpm, respiratory rate 12 bpm, oxygen saturation 93% room air, temperature 37°C), and the patient was unresponsive. He responded to sternal rub with moaning and moved all his extremities to painful stimuli. He smelled of sweet alcohol and did not answer questions. His eyes were open, pupils were reactive, and his head was normocephalic and atraumatic. He had no meningismus and no clonus. Cardiopulmonary and gastrointestinal examinations were normal, and he had no signs of trauma. A fingerstick point of care test indicated that the concentration of glucose in his blood was 27 mg/dl.The patient was given 30 ml of D50W, awoke immediately, jovial and smiling, and was observed for 1 h. While getting 500 ml of D5W, he ate some food, remained normoglycemic, and then was discharged. He did not return within 1 month. His diagnosis was alcohol-related hypoglycemia.A 50-year-old man, known to be an alcoholic, presented after being found unresponsive at home in bed. He had been drinking the night before, but his family members could not arouse him in the morning. He had eaten all three meals the day and night before. Further history elucidated that he had had a cough for 1 month and 2 days of epigastric pain without vomiting, hematochezia, or diarrhea. He had no remarkable medical or surgical history, took no medications, and had no known drug allergies.His examination demonstrated a disheveled man who appeared unresponsive with only gurgling respirations (temperature 34.3°C, pulse 96, blood pressure 90/50, respiratory rate 20, oxygen s