A case of recurrent hypoglycemia in pregnancy

A 33-year-old female who was 34 weeks into her third pregnancy with no previous medical illness developed giddiness and loss of consciousness and was hospitalized. Her capillary blood glucose was found to be 20 mg%. She fully regained her consciousness after 25% dextrose infusion. Over the next 24 h, she developed three more episodes and was similarly treated. After the fourth episode, she deteriorated and in spite of supportive measures expired <36 h after the onset of the illness. Laboratory results showed raised serum creatinine and total leukocyte count (TLC); her abdominal ultrasonogram showed Grade 1 medical renal disease. A routine glucose tolerance test carried out in the 24th week of pregnancy had showed a hypoglycemic tendency. The combination of raised TLC, suggesting an acute bacterial infection, together with the underlying silent chronic kidney disease probably resulted in severe and recurrent hypoglycemia. This case underlines the need to do serum creatinine as part of a routine antenatal check-up.