Prolonged Hypoglycemia in Response to Intravenous Tolbutamide in a Patient with Laennec's Cirrhosis and Severe Malnutrition

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Abstract
A malnourished patient with Laennec's cirrhosis, who had had a sympathectomy, had symptoms of hypoglycemia, moderate signs, symptoms and chemical evidence of hepatic insufficiency, a prolonged hypoglycemic response to tolbutamide and a normal hyperglycemic response to glucagon. An erroneous diagnosis of insulinoma was made. The serum insulin levels before and after tolbutamide were not abnormally elevated, nor was there an abnormally rapid rate of disappearance of the blood glucose after the rapid intravenous infusion of 50% glucose. The patient's history suggests that tolbutamide may cause prolonged hypoglycemia in patients with, hepatic insufficiency, inanition, or after sympathectomy, as well as in patients with insulinoma. Simultaneous serum insulin assays after tolbutamide administration may prove to be useful in differentiating hypoglycemia due to insulinoma from that due to hepatic insufficiency, malnutrition, or other causes.