Journal of UOEH
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A 42-year-old woman visited our hospital with palpitations, excessive sweating, and finger tremors in March 2011. She was diagnosed with Graves' disease based on the following test results: thyroid stimulating hormone < 0.01 μU/ml, free thyroxine 6.15 ng/ml, and thyrotropin receptor antibody 7.8 U/ml. Treatment with methimazole 30 mg and propranolol 30 mg was started, and her thyroid function showed improvement. ⋯ After discharge, her thyroid function remained normal with methimazole 10 mg, and administration of the antipsychotics was discontinued. Affective psychotic symptoms such as altered mood and activity are frequently observed in cases with Graves' disease, but there have been few reports describing cases with full-blown psychiatric disorders manifesting with features such as hallucinations and delusions as the chief symptoms requiring hospitalized treatment, as in the present case. In symptomatic psychosis associated with Graves' disease, prolonged psychiatric symptoms might develop, and close cooperation with psychiatrists is thus important.
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We report a 55 year old Japanese man with a history of alcohol abuse, who was in a near fasting state for the previous few days. He was admitted to our hospital with abrupt disturbance of consciousness. He presented disturbance of consciousness with extreme hypoglycemia and ketoacidosis with high β-hydroxybutyric acid concentration. ⋯ Poor oral intake of this patient was assumed to be the cause of hypoglycemia. Alcoholism may cause hypoglycemia accompanying with AKA, due to a low carbohydrate intake, the inhibition of gluconeogenesis, and reduced hepaticglycogen storage as seen in this case. Here, we report a case of AKA that demonstrated hypoglycemia with the literature review.