Hypoglycemia: Difference between revisions
(Created page with "==Diagnosis== Glucose < 50 there are 28% with disorder Send lytes: if Glucose < 50: 1. U/A: Ketones and Urine organic acids 2. Add cortisol to lytes 3. Insulin if no ket...") |
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==Diagnosis== | ==Diagnosis== | ||
Glucose < 50 there are 28% with disorder | Glucose < 50 there are 28% with disorder | ||
Send lytes: if Glucose < 50: | Send lytes: if Glucose < 50: | ||
#U/A: Ketones and Urine organic acids | |||
#Add cortisol to lytes | |||
#Insulin if no ketones in urine | |||
9,000 glucoses sent--only 40 kids < 50 glucose | 9,000 glucoses sent--only 40 kids < 50 glucose | ||
| Line 21: | Line 12: | ||
3 pts w/ endocrine causes of hypoglycemia | 3 pts w/ endocrine causes of hypoglycemia | ||
BUN is often elevated in FAOD | BUN is often elevated in FAOD | ||
History is key: | History is key: | ||
#Difficulty weaning bottle | |||
#Longest fast | |||
Full labs include (if very low sugar) | Full labs include (if very low sugar) | ||
#LFTs/Hepatomegaly--Glycogen storage | |||
#GH/Cortisol: 'accelerated starvation'/ketotic hypoglycemia or glycogen synthase disorder | |||
If no ketones: | If no ketones: | ||
#Exogenous insulin | |||
#insulinoma | |||
#nesidioblastosis | |||
Critical labs: VBG, Lytes, lactate, NH3, Serum AAs, carnitine, Urine AAs, acylcarnitine, pyruvate. | Critical labs: VBG, Lytes, lactate, NH3, Serum AAs, carnitine, Urine AAs, acylcarnitine, pyruvate. | ||
If glucose < 50: | If glucose < 50: | ||
Plasma glucose, Insulin, GH, Cortisol, free fatty acids, total and free carnitine, U/A for ketones, acyl-carnitine, acyl-glycines. | Plasma glucose, Insulin, GH, Cortisol, free fatty acids, total and free carnitine, U/A for ketones, acyl-carnitine, acyl-glycines. | ||
==Treatment == | ==Treatment == | ||
#hypoG from sulfonylureas | |||
#not expected if taking just metformin or thiazolidinedione- but if these are added to sulfonyl regimen, may get hypoG | |||
#repaglinide can potentially cause hypoG but if skip next dose, should revere | |||
#mostly from sulfonylureas | |||
#ABC's | |||
#Charcoal | |||
#No emetic agents as airway problem as pt get depressed with hypoG | |||
#Consid admit for obs because of long duration of action and delayed clearance- even if pt euglycemic at presentation | |||
#Admit for obs even if only one tablet OD | |||
#Octreotide- inhibits secretion of insulin among others and can be used for sulfonylurea OD with hypoG | |||
#Dextrose itself is an insulin stimulator paradoxically | |||
#Octreotide will treat hyperinsulinism caused by both sulfonyls and dextrose | |||
#Diazoxide- nondiuretic vasodilator used for HTN emergency. Does not suppress insulin lvls like octreotide and therefore is second line to octreotd | |||
#Glucagon- hormone that stimulates hepatic gluconeogenesis- efficacy dependent on hepatic glycogen stores. Not as fast as iv dextrose. Used if can't get iv established- give im | |||
==See Also== | ==See Also== | ||
Endo: Diabetic Meds | Endo: Diabetic Meds | ||
| Line 105: | Line 56: | ||
Peds: Hypoglycemia (Neonatal) | Peds: Hypoglycemia (Neonatal) | ||
==Source == | ==Source == | ||
7/2/09 PANI | 7/2/09 PANI | ||
[[Category:Endo]] | [[Category:Endo]] | ||
[[Category:Tox]] | |||
Revision as of 05:33, 13 March 2011
Diagnosis
Glucose < 50 there are 28% with disorder
Send lytes: if Glucose < 50:
- U/A: Ketones and Urine organic acids
- Add cortisol to lytes
- Insulin if no ketones in urine
9,000 glucoses sent--only 40 kids < 50 glucose
40 kids: 6 w/ fatty acid oxidation defect
3 pts w/ endocrine causes of hypoglycemia
BUN is often elevated in FAOD
History is key:
- Difficulty weaning bottle
- Longest fast
Full labs include (if very low sugar)
- LFTs/Hepatomegaly--Glycogen storage
- GH/Cortisol: 'accelerated starvation'/ketotic hypoglycemia or glycogen synthase disorder
If no ketones:
- Exogenous insulin
- insulinoma
- nesidioblastosis
Critical labs: VBG, Lytes, lactate, NH3, Serum AAs, carnitine, Urine AAs, acylcarnitine, pyruvate.
If glucose < 50:
Plasma glucose, Insulin, GH, Cortisol, free fatty acids, total and free carnitine, U/A for ketones, acyl-carnitine, acyl-glycines.
Treatment
- hypoG from sulfonylureas
- not expected if taking just metformin or thiazolidinedione- but if these are added to sulfonyl regimen, may get hypoG
- repaglinide can potentially cause hypoG but if skip next dose, should revere
- mostly from sulfonylureas
- ABC's
- Charcoal
- No emetic agents as airway problem as pt get depressed with hypoG
- Consid admit for obs because of long duration of action and delayed clearance- even if pt euglycemic at presentation
- Admit for obs even if only one tablet OD
- Octreotide- inhibits secretion of insulin among others and can be used for sulfonylurea OD with hypoG
- Dextrose itself is an insulin stimulator paradoxically
- Octreotide will treat hyperinsulinism caused by both sulfonyls and dextrose
- Diazoxide- nondiuretic vasodilator used for HTN emergency. Does not suppress insulin lvls like octreotide and therefore is second line to octreotd
- Glucagon- hormone that stimulates hepatic gluconeogenesis- efficacy dependent on hepatic glycogen stores. Not as fast as iv dextrose. Used if can't get iv established- give im
See Also
Endo: Diabetic Meds
Peds: Hypoglycemia (Peds)
Peds: Hypoglycemia (Neonatal)
Source
7/2/09 PANI