Episodic Nocturnal Symptoms with Food Relief in Young Adult Male

Case at a Glance

A 20-year-old male presents with recurrent episodes of severe physical and psychological symptoms occurring after prolonged fasting periods, which resolve promptly upon food intake.

Patient's Story

The patient reports experiencing distressing episodes several times per month, typically occurring at night after 6+ hours without food. Episodes begin with unusual sensations in his extremities, which he has learned to recognize as an early warning sign. He describes rapidly escalating symptoms including severe anxiety, panic sensations, tremulousness, and palpitations with heart rates reaching 160 bpm. Additionally, he experiences olfactory hallucinations of chemical odors during these episodes. Symptoms resolve quickly after consuming carbohydrates such as bread or fruit juice.

Initial Assessment

Physical examination reveals an underweight 20-year-old male (BMI 19.5) who appears anxious when describing his symptoms. Vital signs are stable at time of evaluation. Patient demonstrates good awareness of his symptom pattern and has developed coping strategies.

The Diagnostic Journey

Given the clear temporal relationship between fasting and symptom onset, combined with rapid resolution after carbohydrate intake, hypoglycemia was strongly suspected. The constellation of symptoms including tremor, palpitations, anxiety, and unusual sensory phenomena are consistent with neuroglycopenic and adrenergic responses to low blood glucose.

Final Diagnosis

Reactive hypoglycemia with probable underlying glucose regulation disorder

Treatment Plan

Patient advised to maintain regular meal schedule with complex carbohydrates and protein. Glucose monitoring recommended during symptomatic episodes. Dietary consultation arranged for meal planning strategies. Patient educated on recognizing early warning signs and appropriate interventions.

Outcome and Follow-up

Patient scheduled for comprehensive metabolic workup including glucose tolerance testing and HbA1c measurement. Follow-up appointment planned in 4 weeks to assess symptom frequency and review dietary modifications.