Darrow hypoglycemia Flashcards
What is Whipples triad
Sx and signs hypoglycemia
low glcose at time of event <50
reversal with correction hypoglycemia
= INSULINOMA
what are signs of hypoglycemia
confusion, sweating, tachycardia
neuroglycopenic signs hypoglycemia
blurred vision, fatigue, dizziness, HA, confusion, seizures, coma death
what are the sympathoadrenal signs of hypoglycemia
sweating, tachy, tachypnea, anxiety, tremulousness, nausea
patient has hypoglyemic signs and bitemporal hemianopsia
what are you looking for?
MEN syndrome
what will serum insulin be if glucose is <50
less than 5 uU/mL
if inject insulin will you detect C peptide
no!
if suspect insulin cause of hypoglycemia what test is good to do
serum beta hydroxybutyrate which should be low (<2.7)
insulinoma labs
high C peptide proinsulin is high Na and K normal Ca elevated PRL high T4 normal
80% insulinomas are wehre
benign pancreatic ademoas
what are used to Ca stimulate angiography
tobutamide, glucagon and leucine
Tx for insulinomas
surgery, frequent feedings, diazoxide, verapamil, octreotide
how does diazoxide work
opens K channel
how does verapamil work
Ca Ch blocker
non DM F passed out
glucose 30 insulin 7 (normal)
C peptide present
what lab next?
serum sulfonylurea level
25 M with confusion after eating
low glucose
high insulin and C peptide and proinsulin
next test?
72 hour fast to produce hypoglycemia
25 M with confusion after eating
low glucose
high insulin and C peptide and proinsulin
72 hr test fails to produced hypoglycemia
abdominal US -
Dx?
nesidioblastosis (hyperplasia beta cells)
Causes of Hypoglycemia
Renal disease Exogenous drugs Pituitary insufficiency, Pregnancy Liver fialure Adrenal insufficiency, Alcohol Islet cell tmors Neoplasms Sepsis
Drugs that cause hypoglycemia
Sulfonylureas, meglitinides
Alcohol, ASA, Antidysrrhythmics (quinine) Antibiotics, Antimalarials, Acetaminophen overdose
Pentamidine
with low glucose <50 what shoul dinsulin be
low
hypoglycemia after meal
nesidioblastoma
