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Hypoglycemia

Hypoglycemia. By Ahmad soliman abdul halim. Definition. Definition of hypoglycemia. Infant & child : < 47 mg/dl. pathophysiology. Pathophysiology. In Fed State : ↑glucose→↑ insulin secretion → ↑ glucose uptake into cells

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Hypoglycemia

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  1. Hypoglycemia By Ahmad solimanabdulhalim

  2. Definition

  3. Definition of hypoglycemia Infant & child : < 47 mg/dl

  4. pathophysiology

  5. Pathophysiology In Fed State : ↑glucose→↑insulin secretion → ↑ glucose uptake into cells Suppress lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis In fast state : ↓glucose→↓insulin secretion → ↑ lipolysis , gluconeogenesis ,glycogenolysis & ketogenesisWith help of hormones

  6. Causes

  7. CAUSES & CLASSIFICATION OF HYPOGLYCEMIA Hyperinsulinemia (Negtive ketones) Non Hyperinsulinemia state (Postive ketones) • Idm • Psih • PresistentHyperinulinemia • Insulinoma • Induced • Gluconeogensis & glycogen storage defect • Faod • Hormonal :gh & cortisol • Drugs • Idiopathic

  8. Causes of hypoglycemia (HYPERINSULINISM) HYPERINSULINISM (No ketonuria) • IDM • PSIH • Congenital hyperinsulinism • Insulinoma • BWS • Factitious

  9. Causes of hypoglycemia (HYPERINSULINISM) HYPERINSULINISM (No ketonuria) Beckwith-WiedemannSyndrome Congenital hyperinsulinism

  10. Causes of hypoglycemia ( NON HYPERINSULINISM) Gluconeogenesis & glycogen storage defect (ketonuria) • GSD I,III,IV,IX • Fructose 1,6 Diphosphatase • Pyruvate carboxlyse • Galactosemia

  11. Causes of hypoglycemia ( NON HYPERINSULINISM) Gluconeogenesis & glycogen storage defect (ketonuria) glycogen storage defect

  12. Causes of hypoglycemia ( NON HYPERINSULINISM) • Fatty acid oxidation defect Ketogensis defect (No ketonuria)

  13. Causes of hypoglycemia ( NON HYPERINSULINISM) • Hypopituitarism • Addison Hormonal defect ( ketonuria)

  14. Causes of hypoglycemia ( NON HYPERINSULINISM) Drug induced (ketonuria)

  15. Causes of hypoglycemia ( NON HYPERINSULINISM) Ketotic hypoglycemia

  16. Clinical

  17. Clinical picture of Hypoglycemia

  18. approach

  19. CLINICAL APPROACH 1 Confirm The Diagnosis Of Hypoglycemia By Lab Or History Of Proved Pervious Attacks is the case in acute attack or not? 2 How to deal with the case in between acute attack? 3 review your collected data 4

  20. How to deal with case with acute attack? Obtain Urine Or Blood Sample For Ketones,ABG • Ketones present , Acidosis : • suspect • Hormonal deficiency • Gluconeogensis & glycogen defects • Ketotic (idiopathic hypoglycemia) IF YOU CAN DO THIS GO TO THE NEXT STEP Ketones absent, normal ABG: suspect hyperinsulinism or FAOD Try to obtain serum insulin(<5,100uU/ML) , if not elevated review metabolic screen ,if negative review extended metabolic screen Obtain serum cortisol & GH, lactate (10,5ug/dl)

  21. How to deal with case NOT IN acute attack? 1 • Careful history for • Symptoms in relation to meals • Drug history • Other neurological symptoms • Salt craving • Family history of unexplained sibling death 2 • Examine for • Stature • Skin pigmentation • Hepatomegally • Neurological examination Admit to hospital for provocative tests 24hrs fast under careful observation: when symptoms provoked , proceed as step 2 3

  22. Review your data NO KETONES IN URINE OR BLOOD , NORMAL ABG KETONES IN URINE OR BLOOD , ACIDOSIS Postive routine or EMS for FFA Elevated serum insulin Elevated lactate Normal lactate >100uu >5uu Exogenous hyperinsulinism Endogenous hyperinsulinism Drug review Enzyme study + liver biopsy • Hormonal assay (negative) • Enzyme study + liver biopsy • Ketotic hypoglycemia is diagnosis of exclusion • Rviewonset • Image if insulinoma

  23. treatment

  24. TREATMENT

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