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. 2021 Apr 21;14(1):23.
doi: 10.1186/s12245-021-00348-7.

The pathophysiology of "happy" hypoglycemia

Thomas Loeb  1 , Anna Ozguler  2 , Geraldine Baer  3 , Michel Baer  1
Affiliations

The pathophysiology of "happy" hypoglycemia

Thomas Loeb et al. Int J Emerg Med. .

Abstract

Background: Hypoglycemia usually includes various neurological symptoms, which are the consequence of neuroglycopenia. When it is severe, it is associated with altered mental status, even coma.

Case presentation: We report the case of a patient with severe hypoglycemia, completely asymptomatic, due to the increase of lactate production in response to tissue hypoperfusion following a hemorrhagic shock. This illustrates that lactate can substitute glucose as an energy substrate for the brain. It is also a reminder that this metabolite, despite its bad reputation maintained by its role as a marker of severity in critical care patients, has a fundamental role in our metabolism.

Conclusions: Following the example of the "happy hypoxemia" recently reported in the literature describing asymptomatic hypoxemia in COVID-19 patients, we describe a case of "happy hypoglycemia."

Keywords: Asymptomatic; Emergency medical service; Hypoglycemia; Lactate.

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Conflict of interest statement

The authors declare that they have no competing interests.

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