A Veteran Presenting With Symptomatic Postprandial Episodes.

Dayna Isaacs, Mehran Kashefi, Ian Downs, Jane Weinreb
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Abstract

Background: Idiopathic postprandial syndrome (IPP) presents with hypoglycemic-like symptoms in the absence of biochemical hypoglycemia and remains a diagnosis of exclusion. Its pathophysiology is poorly understood. The diagnosis requires thorough evaluation and the Whipple triad criteria. Treatment typically involves dietary modifications, including reduced carbohydrate intake, increased protein and fiber, and frequent small meals. Continuous glucose monitoring (CGM) may be a useful adjunct in correlating symptoms with glucose trends, but its role is still evolving.

Case presentation: A 41-year-old male veteran presented with chronic postprandial episodes characterized by lightheadedness, nausea, tremulousness, anxiety, and other adrenergic symptoms occurring after carbohydrate-heavy meals. An extensive workup was unremarkable. CGM confirmed normoglycemia during episodes, ruling out true hypoglycemia and supporting a diagnosis of idiopathic postprandial syndrome. He was referred to a nutritionist for guidance on a high-protein, high-fiber, low-carbohydrate diet and subsequently reported symptomatic improvement.

Conclusions: This case highlights the importance of recognizing IPP as a distinct clinical entity, especially due to its nonspecific clinical presentation. Early identification allows for a more accurate diagnosis and targeted treatment through tailored dietary and behavioral strategies, helping to alleviate symptoms.

一位退伍军人出现症状性餐后发作。
背景:特发性餐后综合征(IPP)在没有生化低血糖的情况下表现为低血糖样症状,仍然是一种排除性诊断。其病理生理机制尚不清楚。诊断需要彻底的评估和惠普尔三联征标准。治疗通常包括调整饮食,包括减少碳水化合物的摄入,增加蛋白质和纤维,以及经常少餐。连续血糖监测(CGM)可能是一种有用的辅助手段,可将症状与血糖趋势联系起来,但其作用仍在发展。病例介绍:一名41岁男性退伍军人,慢性餐后发作,表现为重度碳水化合物餐后出现头晕、恶心、颤抖、焦虑和其他肾上腺素能症状。广泛的检查没有什么了不起的。CGM证实发作期间血糖正常,排除了真正的低血糖,支持特发性餐后综合征的诊断。他被转介给一位营养学家,接受高蛋白、高纤维、低碳水化合物饮食的指导,随后报告症状有所改善。结论:该病例强调了将IPP视为一种独特的临床实体的重要性,特别是由于其非特异性临床表现。早期识别有助于更准确的诊断,并通过量身定制的饮食和行为策略进行有针对性的治疗,有助于缓解症状。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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