Informatics Publishing Limited

G. B. Nigam ¹, S. S. Babu ², R. Sharma ¹, C. S. Peter ³, Sobhana ³

Affiliations
1 Department of Medicine, St Stephen's Hospital, Tis Hazari, New Delhi, IN
2 Department of Neurology, St Stephen's Hospital, Tis Hazari, New Delhi, IN
3 Metropolis Labs, Allapuzha, Kerala, IN

Abstract

Two patients of snakebite with neurotoxic symptoms were evaluated for understanding the neurophysiological manifestations of snake venom by electrophysiological testing. The testing revealed evidence of neuromuscular junction dysfunction in both cases with decremental response. This response was more evident on higher stimulation rates indicating a post-synaptic defect distinctive from myasthenia gravis. EMG study in the first case provided a distinction between myokymia and fasciculations. Snake envenomation can often present as a myasthenic syndrome with ambiguous history and in such cases electrophysiology can give a clue to the diagnosis.

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A. Takkar ¹, R. Sharma ¹, H. P. Paljor ¹, G. B. Nigam ¹

Affiliations
1 Department of Medicine, St Stephen's Hospital Tis Hazari, New Delhi, IN

Abstract

Reported here is a case of 32 year old unmarried female presenting with altered sensorium and recurrent hypoglycaemia after a suspected high dose of insulin glargine with suicidal intent. Management of the patient in an intensive care setting with intravenous dextrose, subcutaneous glucagon injections and oral glucose rich diet produced effective results. The measurement of insulin and c-peptide levels helped confirm the diagnosis of insulin overdose.

Keywords

Insulin, Glargine, Overdose, Suicide, Glucagon.

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