• Nicholas M McManus, Kendel M Margart, and Ryan P Offman.
• Emergency Department, West Michigan Emergency Medicine Residency Program, Mercy Health - Muskegon, Muskegon, Michigan; Emergency Department, Lake Michigan Emergency Specialists, Muskegon, Michigan; Emergency Department, Mercy Health - Muskegon, Muskegon, Michigan.
• J Emerg Med. 2021 Apr 1; 60 (4): e77-e79.

BackgroundNoninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a rare syndrome characterized by postprandial hypoglycemia with neuroglycopenic symptoms occurring 1 to 3 h after a meal. Diagnosis can be elusive, as the vast majority of patients have normal fasting blood glucose levels, and onset of hypoglycemic episodes can be a late complication of gastric surgery.Case ReportWe report the case of a 45-year-old woman presenting to the Emergency Department (ED) with new-onset seizures and hypoglycemia worsened by glucose administration. Surgical history is pertinent for a Roux-en-Y gastric bypass approximately 10 years prior to presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although rare, it is important for emergency physicians to be vigilant of this disease process as a traditional treatment approach for hypoglycemia may be detrimental. Although cases of NIPHS have been documented in literature, its presence in emergency medicine-specific literature is seemingly nonexistent. Noninvasive imaging techniques will be normal, and diagnosis is dependent on awareness of this disease entity coupled with a detailed history.Copyright © 2020 Elsevier Inc. All rights reserved.

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