• J Harder, K Mikesch, L Mohr, and H E Blum.
• Abteilung Innere Medizin I, Medizinische Klinik, Albert-Ludwigs Universität Freiburg. harder@medizin.ukl.uni-freiburg.de
• Dtsch. Med. Wochenschr. 2005 Mar 18; 130 (11): 574-6.

HistoryA 64-year old somnolent man was admitted to the emergency department with a reported seizure half an hour earlier. Due to similar episodes the patient had been treated with antiepileptics in the past. The patient s past history revealed a partial gastrectomy (Billroth II) more than ten years ago.Diagnostic Findings And TherapyAt the time of admission blood glucose was 31 mg/dl. Other routine laboratory analyses and the clinical examination were normal. In addition, a detailed neurological examination and a cranial CT-scan were normal. Due to the hypoglycemia a dumping syndrome was suspected. A three hour oral glucose tolerance test (OGTT) resulted in a late hypoglycemia, establishing the diagnosis of late dumping. After adaptation of the patient's diet no further hypoglycemic episodes occurred.ConclusionManifestation of a dumping syndrome may occur even years after gastrectomy. Therefore, in patients presenting with hypoglycemia and a history of gut surgery, a dumping syndrome should be suspected. Furthermore, seizures due to hypoglycemia may be the only manifestation of late dumping.

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