Abstract #1403051: Hypoglycemia After Ingestion of Street “Valium” Containing Glyburide, Alcohol, and Cocaine

Sulfonylureas increase the release of endogenous insulin, which can lead to hypoglycemia with overdose or ingestion by nondiabetic patients. Alcohol is metabolized liver resulting in decreased gluconeogenesis hypoglycemia. Cocaine not known cause but cocaine use and have a similar clinical presentation. A 33-year-old male history narcotic dependence anxiety was admitted after being found unresponsive diaphoretic. Paramedics reported glucose 18 milligram per deciliter (mg/dL) that increased 109 mg/dL D50W administration. He regained consciousness at scene developed recurrent Prior medical encounter, patient bought on street ingested 2 unmarked light blue pills thought be valium treat his anxiety. Subsequently, he diaphoresis weakness consumed alcohol attempt relieve these symptoms. Twenty hours initial pills, lost consciousness. Venous emergency room 15 mg/dL. Initiation infusion progressively improved blood values over twenty hours. Once alert oriented, no personal family diabetes. Toxicology screen positive for benzodiazepines, cannabis, cocaine. Laboratory were notable insulin 47.4 milli-international units milliliter (mIU/mL) (2.6-24.9), C-peptide 5.4 nanograms (ng/mL) (1.1-4.4), 44 Patient underwent 72 hour fast did suggest insulinoma. Sulfonylurea glyburide. discharged home stable condition. induced leads sedation, mimicking effects benzodiazepines opioids. sold street, misbranded as mixed This has opened window opportunity misuse medications. consumption hypoglycemia, however mechanism differs from sulfonylurea, opioid, benzodiazepine When taken combination, severe result. Physicians should aware this possibility consider intentional unintentional sulfonylurea abuse, without other drugs.