A mixed-poisoning case linked severe hypoglycemia with elevated endogenous insulin markers, illustrating a competing explanation for unconsciousness.
An unconscious man had profound, difficult-to-correct hypoglycemia and recurrent circulatory arrest. Toxicology found tramadol and metabolites along with several other medicines, including lormetazepam. Insulin and C-peptide were inappropriately elevated, leading the authors to propose tramadol-associated stimulation of insulin secretion.
A sedative may contribute to reduced responsiveness, but its presence does not explain severe biochemical abnormalities by itself. The case also cannot definitively isolate every ingested drug’s role or quantify a lormetazepam contribution. The mechanism proposed for hypoglycemia remains based on one clinical observation and supporting laboratory findings. Forensic interpretation should integrate glucose, endocrine testing, toxicology, resuscitation, and timing rather than assigning unconsciousness solely to a positive benzodiazepine finding.
Original analysis of the supplied journal article, identified as PMC6904963.