Editorials Hypoglycemia in Congestive Heart Failure

Episodes of disordered behavior, coma or convulsions are not infrequent during the course of severe, chronic, congestive heart failure. When observed, they are usually attributed to some process such as anoxemia, a cerebral vascular disturbance, drug intoxication, electrolyte imbalance, or some other alteration directly or indirectly related to the underlying cardiac disorder. The importance of the early recognition of the remediable causes of such occurrences is obvious, and hence the considerable therapeutic significance of the observation that they may occasionally be due to periods of hypoglycemia, readily reversed by the simple act of administering adequate glucose.' Such episodes of hypoglycemia have been observed in a group of patients with chronic congestive heart failure due to a wide variety of causes including rheumatic fever, syphilis, coronary sclerosis and myxoma of the left atrium. The common feature of all of these patients has been congestive failure of very considerable degree and of prolonged duration. It is not at all difficult to overlook hypoglycemia as the cause of such manifestations as sweating, palpitations, peculiar behavior, lack of responsiveness and convulsions in a patient who is seriously affected by congestive heart failure. The symptoms and signs of hypoglycemia are nonspecific and may be produced by a number of other conditions which are commonly part and parcel of advanced cardiac failure. It is not surprising, therefore, that hypoglycemia has often been overlooked as a cause of these manifestations and frequently recognized ultimately only by virtue of a chance laboratory determination. It is only through constant awareness that hypoglycemia may complicate the course of congestive heart failure and produce these varied alterations that one can apply the dramatic therapeutic as well as diagnostic maneuver of giving glucose to the patient which may be life saving. Before administering glucose it is, of course, helpful to obtain a blood speci-