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Hypoglycemia - Symptoms

Sweating Tachycardia Anxiety Hunger Paresthesias Palpitations. Altered LOC Dizziness Seizures Coma Blurred vision Hypothermia. Hypoglycemia - Symptoms. Central nervous system glucose deprivation. Discharge of the sympathetic nervous system. Documented hypoglycemia Symptoms

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Hypoglycemia - Symptoms

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  1. Sweating Tachycardia Anxiety Hunger Paresthesias Palpitations Altered LOC Dizziness Seizures Coma Blurred vision Hypothermia Hypoglycemia - Symptoms Central nervous system glucose deprivation Discharge of the sympathetic nervous system

  2. Documented hypoglycemia Symptoms Symptoms resolve w/ Glucose Whipples Triad

  3. Fasting (Post absorptive) If reproducible, implies disease, requires w/u Occurs after a fast or exercise Do an overnight fast Etiology Drugs Critical illness Hormonal deficiencies Hyperinslinism Reactive (Post prandial) Reactive Usually not serious, self limiting Etiology Idiopathic, s/p gastric surgery, rarely enzyme defect Hypoglycemia Most serious

  4. Alimentary hyperinsulinism Hereditry fructose intolerance Galactosemia Leucine Sensitivity Idiopathic Etiology –Fasting hypoglycemia • Artifact • Leukocytosis • Polycythemia

  5. Endocrinopathy Adrenal insufficiency Hypopituitary Glucogon deficiency Catacholamine deficiency Starvation Organic Acute liver failure Chronic renal failure Acute CHF Drugs Alcohol Propanolol, Salicilates Hypothermia Overutilization of Glucose Drugs Insulin,, Sulfonylureas, Quinine, Disopyramine, Pentamidine, Sulfonamides Tumor Insulinoma Infection Septicemia, Malaria Etiology –Fasting hypoglycemia Impaired production

  6. Emergency Department Presentation 2/3 Hx Diabetes 2/3 Recent ETOH use 1/4 Septic Comment: Think of hypoglycemia in septic, drunk diabetics Hospitalized 60% Drugs (Insulin, sulfonylureas, ETOH) 15% Renal disease 15% Liver disease Others malnutrition and sepsis Hypoglycemia

  7. Identification Hx & PE Collect blood during hypoglycemic episode Check Glucose, Draw and hold blood for Insulin (C-peptide and Proinsulin) and specific drug screen Treatment Glucose Repeat serum glucose Treat primary problem Work Up

  8. Resolved hypoglycemia Resolution of symptoms Identification of primary problem Severity Likelihood or reoccurrence Use caution w/ patients on long acting oral hypoglycemics Food Social issues Food Live alone Was this an OD? Are there hypoglycemic drugs in the home? Healthcare worker Admission/Discharge

  9. In diabetics, hypoglycemia is almost always related to medication In a nondiabetic with confusion, LOC, Sz, a workup is required Hypoglycemia in a nondiabetic w/o sepsis. Liver dz, renal dz, or Hx of ETOH should raise the suspicion of an insulinoma, tumor, hormonal, etc Clinical Pearls

  10. Poorly controlled IDDM will suffer hypoglycemia at a higher glucose level Pt w/ controlled IDDM and insulinomas can tolerate lower glucose levels Neurohypoglycemia ~ 54 Arterial gluc levels are higher (30%) Use caution in pts on beta blockers More Pearls

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