Hypoglycemia: Difference between revisions
Kghaffarian (talk | contribs) No edit summary |
|||
| Line 15: | Line 15: | ||
**Tachycardia or bradycardia | **Tachycardia or bradycardia | ||
**Salivation | **Salivation | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 21:59, 27 August 2015
Background
- Brain depends on glucose as primary source of energy, but is unable to synthesize or store glucose
Clinical Features[1]
- Neuroglycopenic
- Altered mental status, lethargy, confusion
- Focal neurologic deficits
- Unresponsiveness
- Autonomic
- Anxiety, nervousness, irritability
- Nausea, vomiting
- Palpitations
- Tremor
- Changes in pupil size
- Tachycardia or bradycardia
- Salivation
Differential Diagnosis
- Adrenal insufficiency
- Head trauma
- Hepatic failure
- Insulinoma
- Medication-induced
- Seizure
- Sepsis
- Stroke
- Sympathomimetic toxicity
- Toxic ingestion
Diagnosis[2]
- Symptoms consistent with the diagnosis
- See Clinical Features
- Blood glucose level usually <50 mg/dL
- Whole blood glucose approximately 15% less than serum or plasma
- Symptoms resolve with glucose administration
- Determine etiology of hypoglycemia
Management
- If altered mental status
- Dextrose 50% 50mL bolus (equals "one amp")
- Contains 25mg glucose
- Dextrose 50% 50mL bolus (equals "one amp")
- If awake
- Oral glucose
- Glucagon[3]
- Efficacy dependent on hepatic glycogen stores
- Onset of action slower than IV dextrose (7-10min)
- 1mg SC or IM
Hypoglycemia from Sulfonylureas[4][5]
Activated charcoal[6]
- Administer activated charcoal, preferably within 1 hr of ingestion
- Multiple doses may be beneficial, especially for glipizide
Glucose Treatment
- Initial therapy regardless of known cause
- Adults
- 50mL D50W bolus
- Start a D10 1/2NS drip (100mL/hr)
- Children
- 1mL/kg of D50W OR
- 2mL/kg D25W OR 5-10mL/kg D10W
- Neonate: 5-10 mL/kg D10W
Octreotide[7]
- Theoretical benefit to reduce risk of recurrent hypoglycemia
- Hyperpolarization of the beta cell results in inhibition of Ca influx and prevents insulin release
- 50-100 mcg subcutaneous in adults with repeat dosing Q6hrs
- 2 mcg/kg (max 150mcg) subcutaneously Q6hrs should be used in children
- Continuous infusion of 50-125 mcg/hr is an alternative in adults
- Administer octreotide for 24 hours, then after discontinuing, monitor for hypoglycemia for another 24 hours
Special Considerations
- Glucagon 5mg IM may be used as temporizing measure, e.g. while obtaining IV access
Hypoglycemia from Long Acting Insulin
- Similar treatment as for Sulfonylureas except no role for Octreotide
- Treatment should include oral intake as well as maintenance glucose containing drip either D5 or D10
Disposition
- Admit for refractory hypoglycemia, sulfonylurea-induced hypoglycemia or long acting insulins
See Also
References
- ↑ Jalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432
- ↑ Jalili M. Type 2 Diabetes Mellitus In: Tintinalli's Emergency Medicine. 7th ed. McGraw Hill. 2011:1431-1432
- ↑ 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
- ↑ Rowden AK, Fasano CJ. Emergency management of oral hypoglycemic drug toxicity. Emerg Med Clin N Am 2007; 25:347-356
- ↑ Howland MA. Antidotes in Depth: Octreotide. In: Flomenbaum NE, Goldfrank LR, Hoffman RS et al, eds: Goldfrank’s Toxicologic Emergencies. New York NY, 2006;770-773
- ↑ Tran D et al. Oral Hypoglycemic Agent Toxicity Treatment & Management. Jul 14, 2015. http://emedicine.medscape.com/article/1010629-treatment#showall.
- ↑ Fasano CJ et al. Comparison of Octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med 2008; 51:400-406