Hypoglycemia: Difference between revisions

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==Diagnosis==
==Diagnosis==
Glucose < 50 there are 28% with disorder
#Symptoms consistent with the diagnosis
#Symptoms associated with a low glucose level, usually <50
#Symptoms resolve with glucose administration


Send lytes: if Glucose < 50:
==DDX==
#U/A: Ketones and Urine organic acids
#Medication-induced
#Add cortisol to lytes
#Sepsis
#Insulin if no ketones in urine
#Toxin
 
#Insulinoma
9,000 glucoses sent--only 40 kids < 50 glucose
#Hepatic failure
 
#Adrenal insufficiency
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 ==
==Treatment ==
#hypoG from sulfonylureas
#Hypoglycemia from insulin
#not expected if taking just metformin or thiazolidinedione- but if these are added to sulfonyl regimen, may get hypoG
##D50
#repaglinide can potentially cause hypoG but if skip next dose, should revere
##PO diet
#mostly from sulfonylureas
##Glucagon
#ABC's
###Efficacy dependent on hepatic glycogen stores
#Charcoal
###Onset of action slower than IV dextrose (7-10min)
#No emetic agents as airway problem as pt get depressed with hypoG
###1mg SC or IM
#Consid admit for obs because of long duration of action and delayed clearance- even if pt euglycemic at presentation
#Hypoglycemia from sulfonylureas
#Admit for obs even if only one tablet OD
##D50
#Octreotide- inhibits secretion of insulin among others and can be used for sulfonylurea OD with hypoG
##Octreotide
#Dextrose itself is an insulin stimulator paradoxically
###Used to reduce risk of recurrent hypoglycemia
#Octreotide will treat hyperinsulinism caused by both sulfonyls and dextrose
###50-100mcg SC
#Diazoxide- nondiuretic vasodilator used for HTN emergency.  Does not suppress insulin lvls like octreotide and therefore is second line to octreotd
##Do NOT use glucagon (stimulates insulin release)
#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
##Consider admission for obs b/c of long duration of action and delayed clearance


==See Also==
==See Also==
[[Diabetes (Meds)]]
*[[Diabetes (Meds)]]
 
*[[Hypoglycemia (Peds)]]
[[Hypoglycemia (Peds)]]
*[[Hypoglycemia (Neonatal)]]
 
[[Hypoglycemia (Neonatal)]]


==Source ==
==Source ==
7/2/09 PANI
Tintinalli


[[Category:Endo]]
[[Category:Endo]]
[[Category:Tox]]

Revision as of 07:31, 27 September 2011

Diagnosis

  1. Symptoms consistent with the diagnosis
  2. Symptoms associated with a low glucose level, usually <50
  3. Symptoms resolve with glucose administration

DDX

  1. Medication-induced
  2. Sepsis
  3. Toxin
  4. Insulinoma
  5. Hepatic failure
  6. Adrenal insufficiency

Treatment

  1. Hypoglycemia from insulin
    1. D50
    2. PO diet
    3. Glucagon
      1. Efficacy dependent on hepatic glycogen stores
      2. Onset of action slower than IV dextrose (7-10min)
      3. 1mg SC or IM
  2. Hypoglycemia from sulfonylureas
    1. D50
    2. Octreotide
      1. Used to reduce risk of recurrent hypoglycemia
      2. 50-100mcg SC
    3. Do NOT use glucagon (stimulates insulin release)
    4. Consider admission for obs b/c of long duration of action and delayed clearance

See Also

Source

Tintinalli

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