Unexplained Tachycardia in a Diabetic Patient after Induction: Hypoglycemia, a Commonly Overlooked Cause

Abstract

  Hypoglycemia is an under-recognized cause of intraoperative tachyarrhythmias because autonomic warning signs are obscured under general anesthesia. We report a 52-year-old male with type 2 diabetes mellitus who developed ventricular tachycardia and persistent tachycardia immediately after induction for endoscopic combined intrarenal surgery. Despite adequate anesthetic depth and stable hemodynamics, the arrhythmia did not respond to lignocaine. Point-of-care glucose testing revealed severe hypoglycemia (44 mg/dL), and dextrose administration rapidly normalized the heart rate. Opioid-induced alterations in glucose metabolism and diabetic autonomic neuropathy likely contributed. This case underscores the need to consider hypoglycemia in the differential diagnosis of unexplained intraoperative tachycardia in diabetic patients and to perform early glucose assessment.