Himawan Sanusi Internal Medicine University of Hasanuddin Makassar Hypoglycemia O Defined as serum glucose less than 50-60 mg/dL
O Hypoglycemia is cause of 7% of people arriving to
ED for change in mental status
O Glucose is an obligate metabolic fuel for the brain.
Pathophysiology O First defense is decrease in insulin secretion O Glucagon and epinephrine then stimulate hepatic glucose production O Glycogen reserve is limited and and will be depleted after 24-48 hours of fasting O With continued fasting, gluconeogenesis becomes primary source of glucose Sign and symptoms of Hypoglycemia Clinical Features of Hypoglycemia Symptoms O Autonomic : O adrenergic: palpitations, tremor, and anxiety; O cholinergic: sweating, hunger, and paresthesia) O Neuroglycopenic (behavioral changes, confusion, fatigue, seizure, loss of consciousness, O severe and prolonged death Sign : O Tachycardia, elevated systolic blood pressure, pallor, and diaphoresis may be present Etiology of hypoglycemia 1. Drugs: insulin, insulin secretagogues, alcohol, high doses of salicylates, sulfonamides, pentamidine, quinine, quinolones 2. Critical illness : hepatic, renal, cardiac failure; sepsis; and prolonged starvation 3. Hormone deficiencies : adrenal insufficiency, hypopi tuitarism 4. Insulinoma: pancreatic, cell tumor, cell hyperplasia (a.k.a. nesidioblastosis; congenital or after gastric or bariatric surgery) 5. Other rare etiologies: Non- cell tumors (large mesenchymal or epithelial tumors producing IGF-II, other non- pancreatic tumors), insulin or insulin receptor antibodies, inherited enzymatic defects Hypoglycemia in DM ,
inadequate food intake
incorrect dosing of meds
increased physical exertion
Diagnosis O Blood glucose should be drawn at the time of symptoms, whenever possible before the administration of glucose,
O Should always be considered with altered mentation
O Rapid bedside testing should be performed on all
patients that present as stroke, TIA, seizure disorder, narcolepsy, psychosis Treatment O Initial mgt is admin of 1 g/kg body weight of dextrose as D50W in adults. This can be followed by D10W at a rate ot maintain glucose 100mg/dL or more.
O Oral replacement is best. 300 grams of carbs
should be given PO as soda, crackers, juices Treatment O Oral replacement is best. 300 grams of carbs should be given PO as soda, crackers, juices
O Acute therapy of hypoglycemia requires
administration of oral glucose or 25 g of a 50% solution IV followed by a constant infusion of 5 or 10% dextrose
O Hypoglycemia from sulfonylureas is often prolonged,
requiring treatment and monitoring for 24 h or more
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