Endocrine Abstracts

Introduction: Although psychiatric manifestations in the form of delirium, confusional states, and psychosis have been commonly reported in relation to hypoglycemia, association of hyperglycemia with psychiatric manifestations has been less commonly reported. Acute hyperglycemia is known to alter mood state and impairs cognitive performance in patients with diabetes mellitus. However, association of acute psychosis (in the absence of cognitive disturbances) with hyperglycemia has not been reported. It is generally accepted that alcohol-related psychosis remits with abstinence.

Case report: We report the case of a male 67 years old diagnosed with diabetes mellitus (DM) 3 years ago, treated with combined hypoglycemic oral medications, which has been discontinued for some days. He consumed high quantities of alcohol for many years, but he had stopped drinking for two days. He presented in emergency unit with these complaints: Vomiting, epigastric pain, Polyuric-polydipsic syndrome, fatigue, agitation. Familiar history negative. Objectiv examination: conscious, active position, low turgor skin, dry tongue, rhythmic heart rate, TA 110/60 mmHg, Fc 88/1 min. lungs normal, lower limbs neither edemas nor wounds. Blood biochemistry: glycemia 615 mg/dl, urea 82 mg/dl, creatinine 3.7 mg/dl, AST 49U/L(0–35), AlT 23 U/L(0–45), LDH 340 U/l (0.3–1.2),total protein 5.9 g/dl (6.2–8.3), troponin 0.283 ng/ml. WBC 5100, Granulocyte 80.2%, lymphocytes and monocytes normal. RBC 3.14 million/mm³, HGB 10.9, PLT 187/mm³, MCV micron/m³ 100 (80–97), urine analyses: negative acetone, albumin 2.64 g/leukocyte filled areas, 4–5 erythrocytes/field. Imagery examination:Abdominal ultrasonography, hepatosteatosis, liver with large dimension 158 mm, rough echo structure, portal vein 11 mm, pancreas normal.without peritoneal liquid. According to surgeon consultation, the patient was without acute surgical problems. He was treated with Insulin, fluids, electrolytes,thiamine, antibiotics.The next day: The general condition was better but he had visual hallucinations and he wanted to leave the hospital during the night. Psychiatrist Consultation: Psychotic Symptoms caused by alcohol abstinence. After starting of the psychiatrist treatment with Librium 10 mg 3x1 tb, haloperidol 2×10 drops, he was feeling better.

Conclusion: Psychosis in a diabetic person (alcohol user) with hyperglycemia, can be caused by stopping drinking for only some days. Every physician must be aware about this situation to diagnose it early, and to prevent sad results.