Last year, about this time, my brother-in-law was diagnosed with pancreatic and liver cancer (see this thread).
As I understand it, he took a course of an experimental chemotherapy (mentioned here), and responded so well to it that he was effectively cancer-free by summer.
Two weeks ago, he threw a clot from his lung to his heart, and suffered a massive heart attack. After about ten days in ICU (going from intubation to an oxygen mask), he was moved out of ICU and then discharged, both last Thursday.
Saturday morning, at about 0200, he got up out of bed (why is unclear), and almost immediately collapsed with a blood sugar of 30 mg/dl. His daughter called paramedics and attempted resuscitation to raise his blood sugar. After about 45 minutes, he was pronounced dead.
Until I learned about the blood sugar, and the unsuccessful attempts to raise it, my initial thought was that he had thrown another clot. But now, I find myself thinking about the role that the liver plays in boosting blood sugar.
Is it possible or likely that he had a sudden catastrophic liver failure? Or is the above narrative entirely inadequate to even begin to guess?
Cancer of the liver has been known to cause hypoglycemia. I believe this is entirely plossible.
Chemotherapy and hospital stays have also been linked to hypoglycemia, because anything that causes a person to eat less contributes to low blood sugar. Drug interactions may also contribute. It may not have been a “catastrophic” liver failure so much as a combination of contributing conditions.
It could have been a return of the cancer. It could have been after-effects of the chemo. It could have been scarring of the pancreas.
The low blood sugar was probably just ONE of many symptoms.
Untold appreciation to your brother-in-law for participating in a clinical study. People who do so are true heroes, and while they may or may not personally benefit from the experimental drugs, the results they provide will help to treat future patients.
And it does sound like he got SOME benefit. I hope the family was able to enjoy and appreciate the extra time they received with him.
Hmmm… I wouldn’t think that a blood sugar of 30 would be enough on its own to cause collapse and death. I’ve been that low before, and honestly, other than feeling shaky, I was fine. Scared and eating a ton of sugar, but fine - walking, coherent, etc.
Of course, the minute I find I’m that low, I start eating like a madwoman immediately. Not sure what would happen if I let it go (and certainly not planning on finding out.)
But everyone’s different. Maybe one of the board docs will have more explanation.
Yes, he got to enjoy his months of good health quite nicely. Evidently, he received a pretty substantial monetary settlement from his former employer, and over the summer he took his entire family (wife and four grown children, and assorted spouses) on a cruise to the Bahamas.
His wife is devastated. She really believed he had beaten all the odds.
“Sudden catastrophic liver failure” is not a cause of sudden death, and hypoglycemia would be an unusual primary cause of sudden death in a patient not on exogenous hypoglycemics.
Clots formed in the lungs rarely embolize a coronary artery, so that part of the history confuses me. Note that on rare occasions, a clot formed in the systemic veins can pass through a patent foramen ovale (a hole in the heart from birth that never closed) and embolize the left side arterial system somewhere, including the coronary arteries. Otherwise the usual sorts of clots that kill you pass through the right side of the heart into the pulmonary artery and choke off the circulation at the level of the large pulmonary arteries; they don’t get to the left (systemic-side) side circulation.
As you are probably aware, adenocarcinomas–and classically, pancreatic ones–can be associated with hypercoagulable (clot-making) states (look up Trousseau’s syndrome) so the general association of venous clotting with emboli to the lung and elsewhere would make sense if his primary cancer was pancreatic adenoCA with metastasis to the liver (and it sounds like it was).
A bedside blood sugar run at an arrest is a little more likely to have error than one run under more controlled settings.
Nevertheless, in this scenario, with a recent antecedent history of near-catastrophic clotting with embolic sequelae, I’d say the statistical likelihood is another blood clot, this time fatal.
Overall, though, not enough data. An autopsy would be required. In addition, he may have been on anticoagulants, and that adds additional possibilities for sudden collapse, including intracerebral hemorrhage (though this is not typically instantly fatal).