Reflection: Triple Flexion
A 63-year-old woman collapsed in coma while shopping
and was brought to the hospital. Additional history obtained from the family
by phone revealed that she was taking insulin for adult onset diabetes and a
for hypertension, but was otherwise well.
On examination, the blood pressure was 170/90,
pulse 84/min, and temperature 99.6. Respirations were Cheyne-Stokes
but somewhat irregular at 16/min. The pupils were pinpoint, but appeared to
be minimally reactive when viewed with a hand lens and a bright light. There
was no eye movement, either in response to passive head turning, or to irrigating
the external auditory canals with ice water. The extremities were flaccid
with symmetrical DTRs
of normal amplitude. Plantar stimulation caused flexion at the hip, knee, and
flexion) as well as dorsiflexion
of the great toe.
Blood was drawn for routine analysis and she was given intravenous glucose without any change in her condition.
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