A patient had a dental appointment at 4 PM. During the appointment, the patient begins sweating, looks pale, and reports lightheadedness. What is most likely happening?

Correct answer: A. Insulin shock (hypoglycemia)

• A. CORRECT — This is a classic presentation of hypoglycemia (insulin shock). A late afternoon appointment, missed lunch, or excess insulin activity leads to low blood glucose. Sympathomimetic symptoms (sweating, pallor, lightheadedness, tachycardia) are characteristic. Treatment: oral glucose (if conscious) or IV dextrose/glucagon.
• B. INCORRECT — Adrenal crisis presents with severe hypotension, weakness, nausea/vomiting in patients on corticosteroids — not the typical picture described.
• C. INCORRECT — Hyperglycemia presents gradually with polyuria, polydipsia, blurred vision, and fruity breath — NOT acute sympathomimetic symptoms.
• D. INCORRECT — DKA presents over hours to days with nausea, vomiting, Kussmaul breathing, fruity breath, and extreme hyperglycemia — not acute sweating and pallor.