Abstract
A 69-year-old man on maintenance hemodialysis (HD) due to chronic glomerulonephritis, was admitted to our hospital because of consciousness disturbance. On admission, he showed semicoma, conjugate deviation of the eyes to the left, and horizontal nystagmus. Computed tomography and angiography of the brain was performed, but there were no findings that could explain his manifestation. Laboratory findings reflected systemic inflammation and disseminated intravascular coagulation. After HD on the day of admission, he developed severe hypoglycemia and needed frequent intravenous injection of glucose solution. His consciousness and general condition did not improve and he died the next day. Pathological anatomy demonstrated vegetation of the mitral valve consisting of gram positive bacteria, and also manifested bacterial embolisms of systemic organs including the brain particularly in the bilateral cerebellums. He was diagnosed with infectious endocarditis, and his nervous symptoms were proven to have been caused by micro-bacterial-embolism of the brain. Severe hypoglycemia was thought to have been induced by sepsis. Sepsis rarely induces hypoglycemia to adults, unless the patient has a metabolic glucose disorder in his background, such as liver cirrhosis, chronic renal failure or other conditions. We should note that sepsis is one of the main cause of hypoglycemia in HD patient.
