The patient underwent transoesophageal echocardiography on Day 3 of his admission. This showed severe global biventricular dysfunction, moderate to severe mitral regurgitation as a result of annular dilatation, biatrial enlargement, and the presence of spontaneous echo contrast in the left atrial appendage without thrombus. Electrical cardioversion was performed, resulting in sinus tachycardia; however, AF recurred within 24 hours. Pharmacological therapy to promote sinus rhythm included intravenous amiodarone (300 mg immediately, followed by 1200 mg over 24 hours) followed by oral loading (400 mg three times a day).
Steroid diabetes must be distinguished from stress hyperglycemia , hyperglycemia due to excessive intravenous glucose, or new-onset diabetes of another type. Because it is not unusual for steroid treatment to precipitate type 1 or type 2 diabetes in a person who is already in the process of developing it, it is not always possible to determine whether apparent steroid diabetes will be permanent or will go away when the steroids are finished. More commonly undiagnosed cases of type 2 diabetes are brought to clinical attention with corticosteroid treatment because subclinical hyperglycemia worsens and becomes symptomatic. Generally, steroid diabetes without preexisting type 2 diabetes will resolve upon termination of corticosteroid administration.