A 25-Year-Old Man Is Brought to the Emergency Department Due

question 196

Multiple Choice

A 25-year-old man is brought to the emergency department due to acute-onset dizziness, weakness, sweating, and confusion.  The patient has a blood glucose level of 36 mg/dL, and his symptoms resolve with intravenous dextrose.  He has no medical conditions and takes no medications.  The patient has smoked intermittently for the last 5 years but does not use alcohol or illicit drugs.  He is unemployed and lives with his parents.  His father has type 2 diabetes mellitus and takes metformin and glyburide.  His mother has hypertension treated with lisinopril.
Physical examination is unremarkable.  The patient is hospitalized for observation.  On the second day, he develops similar symptoms with a blood glucose level of 34 mg/dL; intravenous dextrose is again administered and his symptoms improve.
Laboratory results drawn during the second episode of hypoglycemia are as follows:
Which of the following is the best next step in evaluation of this patient?

• A)CT scan of the abdomen
• B)Glucagon challenge
• C)Insulin autoantibody levels
• D)Oral hypoglycemic drug screen
• E)Prolonged fasting hypoglycemia test

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Definitions:

Mild Hallucinations

Sensory experiences that appear real but are created by the mind, often less intense or disturbing than full-blown hallucinations.

Sensory Awareness

The consciousness or alertness of the sensations experienced through the five senses.

Drug

Any substance that causes a change in an organism's physiology or psychology when consumed.

Multifactorial Causation

A concept that an event or condition is the result of multiple factors working together, not just a single cause.