Probable hypoglycaemia induced by single dose nimesulide.

Probable Hypoglycaemia Induced by Single Dose Nimesulide Sir, A 44 years non-alcoholic non-smoker healthy Hindu male from rural region was admitted with history of body ache and headache from 2-3 hours after a full vegetarian meal for which he took 2 tabs of Nimesulide (100mg each) and slept. Patient was found unconscious by the attendant after 6-8 hrs approximately and was not arousable. He was sweating profusely. Patient was taken to the hospital immediately. On the way to the hospital he vomited once. There was no history of fever, head injury, prolonged fasting, any other drug intake, trauma, alcohol intake, heat exposure, overexertion, chest pain, palpitation. No past history of Hypertension, Diabetes Mellitus, Tuberculosis, Gastric Surgery, Similar episodes, Seizures. On examination patient was afebrile, perspiring profusely and extremities were cold. No pallor, icterus, cyanosis, pedal edema, lymphadenopathy, clubbing. JVP was not raised. Pupils were normal size and reactive to light. Pulse rate was 100/min with regular rhythm, blood Pressure-140/90 mmHg, Respiratory Rate – 18/Min. Cardiovascular, Respiratory system, Abdominal examination was normal. On Central nervous system examination patient was unconscious but moving all four limbs on deep painful stimulus. Eyeball movements were normal. Both nasolabial folds were equal. No other Cranial nerve palsies were detected. The planter reflex was extensor on right and flexor on left. On motor system examination the tone was increased in all four limbs more in Lower limbs than upper limbs, the Deep tendon reflexes were also exaggerated. The sensory system could not be examined. There were no signs of meningeal irritation, no evidence of tongue bite or sign of any external injury. From emergency room the patient was immediately shifted for CT imaging of head and electrocardiograph which revealed no abnormality. The chest X-ray PA view also showed no abnormality. Laboratory Investigations revealed Blood sugar 54mg/dl on admission. Hb – 12.2 gm%, TLC – 13200/cumm, DLC– 85/11/03/01, MP-not seen, Platelets–2.25 lakhs/ cumm Blood Urea-19mg%, S.Creatinine-0.8mg%, S.Bilirubin(total)– 0.9mg%, Serum Cholesterol-146mg%, HDL 36mg%, LDL 57.8 mg%, VLDL 52.2mg%, TG 261mg%.Urine complete examination was also normal. Plasma insulin level was advised, but could not be done due to unwillingness of the patient’s attendant’s. With the Blood Sugar report of 54mg% immediately he was infused with 100cc of 25% dextrose intravenously. Soon after which he regained consciousness with normal higher function and no neurological deficit. Repeat Blood sugar level was 130 mg%. Patient was observed for the next 48hours and he remained conscious and alert with no neurological deficit or recurrence of episode. He was discharged in healthy condition with the diagnosis of hypoglycaemic encephalopathy caused by the intake of Nimesulide.