Hypoglycemia - Revision history

Danbot: Add MedicationDose SMW annotations (4 entries: dextrose adult/peds, glucagon, octreotide); dosing verified

2026-03-20T16:36:45Z

Add MedicationDose SMW annotations (4 entries: dextrose adult/peds, glucagon, octreotide); dosing verified

← Older revision		Revision as of 16:36, 20 March 2026
Line 83:		Line 83:
	*Then localization studies with US, CT, or MRI		*Then localization studies with US, CT, or MRI


			<div style="display:none">
			<!-- SMW MedicationDose annotations for hypoglycemia medications -->
			{{MedicationDose\|drug=Dextrose\|dose=D50W 50 mL (25 g glucose) IV bolus\|route=IV\|context=IV dextrose for AMS/unable to take PO\|indication=Hypoglycemia\|display=Dextrose (D50)\|notes=First line if IV access available}}
			{{MedicationDose\|drug=Dextrose\|dose=D25W 2-4 mL/kg IV; D10W 5 mL/kg IV (neonates)\|route=IV\|context=IV dextrose (pediatric)\|indication=Hypoglycemia\|population=Pediatric\|display=Dextrose (D25/D10)}}
			{{MedicationDose\|drug=Glucagon\|dose=1 mg SC or IM\|route=SC/IM\|context=If unable to achieve IV access\|indication=Hypoglycemia\|onset=7-10 min\|notes=Less effective in chronic ETOH, cirrhosis, malnourished, neonates}}
			{{MedicationDose\|drug=Octreotide\|dose=50-100 mcg SC q8-12h\|route=SC\|context=Sulfonylurea-induced hypoglycemia (prevents rebound)\|indication=Hypoglycemia\|notes=Blocks sulfonylurea-mediated insulin release; prevents rebound hypoglycemia after dextrose}}
			</div>
	==See Also==		==See Also==
	*[[Diabetes Mellitus (Main)]]		*[[Diabetes Mellitus (Main)]]

ClaireLewis: /* Autonomic */

2019-09-28T16:17:41Z

Autonomic

← Older revision		Revision as of 16:17, 28 September 2019
Line 17:		Line 17:
	*[[Nausea and vomiting]]		*[[Nausea and vomiting]]
	*[[Palpitations]]		*[[Palpitations]]
	*Tremor		*[[Tremor]]
	*Changes in pupil size		*Changes in pupil size
	*Tachycardia or bradycardia		*[[Tachycardia]] or [[bradycardia]]
	*Salivation		*Salivation

Rossdonaldson1 at 16:13, 15 March 2019

2019-03-15T16:13:52Z

← Older revision		Revision as of 16:13, 15 March 2019
Line 1:		Line 1:
			''This page is for <u>adult</u> hypoglycemia. See [[non-neonatal hypoglycemia (peds)]] or [[neonatal hypoglycemia]] for pediatric patients.''
	==Background==		==Background==
	*Brain depends on glucose as primary source of energy, but is unable to synthesize or store glucose		*Brain depends on glucose as primary source of energy, but is unable to synthesize or store glucose

Rossdonaldson1: /* EvaluationJalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432 */

2019-03-15T16:09:53Z

EvaluationJalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432

← Older revision		Revision as of 16:09, 15 March 2019
Line 38:		Line 38:
	***Elevated proinsulin and C-peptide during hypoglycemic episode in context of insulinoma		***Elevated proinsulin and C-peptide during hypoglycemic episode in context of insulinoma

	===~~Evaluation~~<ref>Jalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432</ref>===		===Diagnosis<ref>Jalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432</ref>===
	"Whipple's Triad"		"Whipple's Triad"
	*Symptoms suggestive of hypoglycemia		*Symptoms suggestive of hypoglycemia

Rossdonaldson1: /* Management */

2019-03-15T16:07:55Z

Management

← Older revision		Revision as of 16:07, 15 March 2019
Line 55:		Line 55:
	***Contains 25g glucose		***Contains 25g glucose
	**[[Glucagon]] 1mg SC or IM (if unable to achieve IV access)<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>		**[[Glucagon]] 1mg SC or IM (if unable to achieve IV access)<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>
			***Onset of action slower than IV dextrose (7-10min)
	***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>		***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	***Onset of action slower than IV dextrose (7-10min)

	{{Sulfonylurea Toxicity}}		{{Sulfonylurea Toxicity}}

Rossdonaldson1: /* Management */

2019-03-15T16:07:33Z

Management

← Older revision		Revision as of 16:07, 15 March 2019
Line 54:		Line 54:
	**[[Dextrose]] 50% 50mL bolus IV (equals "one amp")		**[[Dextrose]] 50% 50mL bolus IV (equals "one amp")
	***Contains 25g glucose		***Contains 25g glucose
	**[[Glucagon]] 1mg SC or IM<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>		**[[Glucagon]] 1mg SC or IM (if unable to achieve IV access)<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>
	***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>		***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	***Onset of action slower than IV dextrose (7-10min)		***Onset of action slower than IV dextrose (7-10min)

Rossdonaldson1: /* Management */

2019-03-15T16:06:25Z

Management

← Older revision		Revision as of 16:06, 15 March 2019
Line 52:		Line 52:
	**Oral glucose		**Oral glucose
	*If [[altered mental status]] or otherwise unable to tolerate POs		*If [[altered mental status]] or otherwise unable to tolerate POs
	**[[Dextrose]] 50% 50mL bolus (equals "one amp")		**[[Dextrose]] 50% 50mL bolus IV (equals "one amp")
	***Contains 25g glucose		***Contains 25g glucose
	*[[Glucagon]] 1mg SC or IM<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>		**[[Glucagon]] 1mg SC or IM<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>
	**Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>		***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	**Onset of action slower than IV dextrose (7-10min)		***Onset of action slower than IV dextrose (7-10min)

	{{Sulfonylurea Toxicity}}		{{Sulfonylurea Toxicity}}

Rossdonaldson1: /* Management */

2019-03-15T16:05:56Z

Management

← Older revision		Revision as of 16:05, 15 March 2019
Line 49:		Line 49:
	==Management==		==Management==
	[[File:Hypoglycemia Management.png\|thumb\|Algorithm for the management of hypoglycemia]]		[[File:Hypoglycemia Management.png\|thumb\|Algorithm for the management of hypoglycemia]]
	*If [[altered mental status]]		*If awake and able to tolerate POs
			**Oral glucose
			*If [[altered mental status]] or otherwise unable to tolerate POs
	**[[Dextrose]] 50% 50mL bolus (equals "one amp")		**[[Dextrose]] 50% 50mL bolus (equals "one amp")
	***Contains 25g glucose		***Contains 25g glucose
	*If awake		*[[Glucagon]] 1mg SC or IM<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>
	**Oral glucose		**Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	*[[Glucagon]]<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>		**Onset of action slower than IV dextrose (7-10min)
	**1mg SC or IM
	***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	***Onset of action slower than IV dextrose (7-10min)

	{{Sulfonylurea Toxicity}}		{{Sulfonylurea Toxicity}}

Rossdonaldson1: /* Management */

2019-03-15T16:04:24Z

Management

← Older revision		Revision as of 16:04, 15 March 2019
Line 55:		Line 55:
	**Oral glucose		**Oral glucose
	*[[Glucagon]]<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>		*[[Glucagon]]<ref>Carstens S, Sprehn M. Prehospital treatment of severe hypoglycaemia: a comparison of intramuscular glucagon and intravenous glucose. Prehosp Disaster Med. 1998 Apr-Dec;13(2-4):44-50</ref>
	**Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
	**Onset of action slower than IV dextrose (7-10min)
	**1mg SC or IM		**1mg SC or IM
			***Efficacy dependent on hepatic glycogen stores (less effective in chronic ETOH, cirrhosis, malnourished, neonate, in-born errors, glycogen storage disease, etc.)<ref>Cydulka RK, Maloney GE. Diabetes Mellitus and Disorders of Glucose Homeostasis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2013, (Ch) 126: p 1652-1667.</ref>
			***Onset of action slower than IV dextrose (7-10min)

	{{Sulfonylurea Toxicity}}		{{Sulfonylurea Toxicity}}

Jimothy: 50% 50mL bolus contain 25g (not mg) of glucose

2019-03-09T13:28:55Z

50% 50mL bolus contain 25g (not mg) of glucose

← Older revision		Revision as of 13:28, 9 March 2019
Line 51:		Line 51:
	*If [[altered mental status]]		*If [[altered mental status]]
	**[[Dextrose]] 50% 50mL bolus (equals "one amp")		**[[Dextrose]] 50% 50mL bolus (equals "one amp")
	***Contains ~~25mg~~ glucose		***Contains 25g glucose
	*If awake		*If awake
	**Oral glucose		**Oral glucose