Abstract
Disclosure: P. Savani: None. F. Korkmaz: None. A. Kumar: None. V. Escobar Barboza: None. Background: Unresponsive patients can have a wide range of potential causes, including infections, metabolic imbalances, cardiac or neurological conditions, or drug intoxication. Persistent hypoglycemia in someone without diabetes is unusual and should prompt an investigation into drug use or overdose. Here, we share an uncommon case of refractory hypoglycemia caused by PCP (phencyclidine) adulterated by sulfonylurea drug, highlighting a rare but important cause of refractory hypoglycemia. Case: A 48-year-old male with a history of alcohol use disorder, chronic lymphedema, and meningioma was found unresponsive and hypoglycemic (BG 36 mg/dl) by EMS. He received IV dextrose and Narcan with improvement in BG to 90 mg/dl. He regained consciousness but was unable to recall events. Vitals: BP 135/93, RR 18, HR 67, T 97.3°F. Physical exam was unremarkable except for chronic leg edema. Labs showed K+ 3.1 mmol/L, Hb 12.9, MCV 101.8, and positive urine PCP. Head CT revealed stable meningioma. Despite IV dextrose and glucagon, BG repeatedly dropped to 34 mg/dl, accompanied by seizure-like activity. Insulin and C-peptide levels were elevated (72.7 uIU/ml, 6.8 ng/ml). A D5 drip was initiated, escalating to D10 and then D20 due to persistent hypoglycemia. Hydrocortisone was added, leading to eventual stabilization. Urine glipizide was markedly elevated (579 ng/ml), confirming sulfonylurea-induced hypoglycemia, likely from drug adulteration. Discussion: Hypoglycemia can be caused by drugs, critical illness, liver and kidney dysfunction, and conditions related to increased endogenous production of insulin. With the increasing use of recreational drugs, drug adulteration is becoming a common phenomenon. Drugs like benzodiazepine, ecstasy, amphetamine, eutylone, cannabinoids, and cocaine have been reported in the past to be adulterated with sulfonylureas (1)(3). Due to their hypoglycemic effects, sulfonylureas can cause drowsiness making them an easy substitute. Additionally, since they are not classified as controlled substances, they are more affordable and easier to access. Our patient had refractory hypoglycemia, was positive for PCP, and had very high urine glipizide levels confirming the diagnosis. It's important to rule out drug adulteration with sulfonylurea as a potential cause and treat it appropriately with dextrose and octreotide. (2) (1) McKenna AL, Wilson JR, Dumitrascu AG, Meek SE, Chindris A-M. Hypoglycemia after ingestion of “Street Valium” containing glyburide, alcohol, and cocaine. [PMC11294736] (2) Soo JEJ, Ng M, Chong TKL, Tan BKK, Ponampalam R. Persistent refractory hypoglycemia from polysubstance use. Case Rep. 2023; PMC9842469. [10.1136/bcr-2022-251647] (3) Gupta UD, Prasad P, Hlaing PP, Panigrahi K, Deribe Z. Recurrent hypoglycemia with polysubstance abuse and rhabdomyolysis. J Endocr Soc. 2024;8(Suppl_1):bvae163.641. [10.1210/jendso/bvae163.641] Presentation: Sunday, July 13, 2025