Simultaneous hypoglycemia and acute congestive heart failure

Acute congestive cardiac failure and hypoglycemia were observed simultaneously in 27 patients with underlying heart disease. Seventeen of this group had the hypoplastic left heart syndrome, two had transposition of the great vessels, and four had hypoglycemia postoperatively. Liver biopsy in four patients revealed a marked reduction of hepatic glycogen both biochemically and electron microscopically but normal phosphorylase and glucose-6-phosphatase activity. Reduction of their dietary intake and gastrointestinal malabsorption caused by congestive cardiac failure are suggested as possible mechanisms for the observed hepatic glycogen depletion. Constant intravenous infusion of glucose is the method of choice for the treatment of patients with acute congestive cardiac failure and hypoglycemia rather than epinephrine or glucagon. Five patients recovered sufficiently following treatment of hypoglycemia and acute cardiac failure to be discharged from the hospital.