Author: Catherine Burns / Editor: Jason M Kendall / Reviewer: Jolene Rosario / Codes: ELC1, EnP3, OncC3, SLO1, SLO2Published: 22/06/2020

An 86-year-old lady was admitted to the Emergency Department following a vacant episode during the night. Her son heard a ‘bump’ from upstairs and found his mother to be sweaty and flushed, thrashing around in bed, crying out and displaying an erratic breathing pattern. He gave her a sugary drink and called 999. She returned to normal shortly after the sugar load.

She had been having increasingly frequent similar episodes over the past 6 months and had lost a significant amount of weight in the past 2 years. Examination revealed finger clubbing, reduced air entry in the right mid and lower zone of her chest and bilateral pitting oedema to her knees. BM was 7.4 mmol/l on presentation.