Skinny little 72-year-old man, sent in by his nursing home for "aggressive behavior/altered mental status." Apparently he had been throwing food and dishes at breakfast and was cursing at the other residents and staff. He cursed at and didn't recognize his daughter when she came to visit, either.
It took two of us to get him into bed, and three of us to get vital signs--he was fighting and kicking and biting and cursing. The daughter was very distraught--"He's never been like this! He's a sweet guy!" No history of Alzheimer's, no psych history, just some cardiac issues and arthritis.
I immediately thought he was hypoxic, but his color was good, and his oxygen saturation (when we could get it!) was 96% on room air. That was good, because there was no way he would keep a mask on. I was finishing up my triage when I realized in all the hubub, I hadn't gotten a blood glucose level. The patient wasn't diabetic, but we get a glucose level on all patients who are altered.
It was 26 mg/dL. Normal is 70-120 or so. (I was shocked that he was even AWAKE, let alone fighting and kicking!) So five of us held him down, started a line, and gave him 2 amps of 50% dextrose solution. After the first one, he calmed down. After the second, he sat up in bed and said, "Hello ladies! What's all the fuss?" Completely back to normal. We got him started on a little D5W and gave him something to eat.
What I'm wondering is how his blood sugar got that way. Perhaps he took someone else's oral antidiabetic medication by accident?