Profound Hypoglycemia in a Hospitalized Patient: Paraneoplastic Insulin-Like Growth Factor

A 96-year-old African American woman presented from a nursing home to our hospital with bilateral erythematous and edematous legs. Her past medical history included dementia, stage 3 chronic kidney disease, hypertension, and congestive heart failure. She was poorly responsive and unable to answer questions on admission, presumably because of sepsis and dementia. No family or nursing home attendants were around to comment on her baseline mental status. Her arterial blood gas on non-rebreather mask (100% oxygen) was adequate: pH 7.38 (7.35-7.45), pO2 487 (80-100 mm Hg), and pCO2 39 (35-45 mm Hg).