Profound hypoglycaemia and cognitive impairment

A 75 year old diabetic man had an initial admission with drug induced hypoglycaemia following which his hypoglycaemic drugs were stopped; cognitive function on simple bedside tests was normal on this and a subsequent second admission (Abbreviated Mental Test (AMT) score was 8/10 (normal 8–10). However, he was inadvertently represcribed the hypoglycaemic drugs after his second discharge from hospital causing profound hypoglycaemia; following this, his AMT was 5/10 and his behaviour became aggressive and demanding. Investigations including autopsy and CT brain, showed no other cause for this decline; given the temporal relationship between the episode of hypoglycaemia and sudden cognitive impairment, we conclude that the hypoglycaemia was the cause. One must take care when prescribing for the elderly. Copyright © 2001 John Wiley & Sons, Ltd.