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Final Notes > FN: Hypoglycaemia > Flashcards

FN: Hypoglycaemia Flashcards

1
Q

Hypoglycaemia: whipples triad

A
  1. Low plasma glucose
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2
Q

Hypoglycaemia: whipples triad

A
  1. Low plasma glucose
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3
Q

Symptoms

A

Autonomic

Neuroglycopenic

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4
Q

Autonomic onset glucose levels onset of symptoms

A

2.5-3

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5
Q

Neuroglycopenic onset of symptoms glucose level

A

.

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6
Q

Autonomic symptoms

A 
Sweating
Anxiety
Hunger
Tremor
Palpitations
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7
Q

Neuroglycopenic

A 
Confusion
Drowsiness
Seqizures
Personality change
Focal neurology (e.g. CN3)
Coma (
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8
Q

Fasting hypoglycameia causes: EXPLAIN

A 
Usually insulin or sulfonylurea Rx in a known diabetic - excercise missed meal, OD
1. Exogenous drugs
2. Pituitary insufficiency
3. Liver failure
4. Addison;s
5. Islet cell tumours (insulinomas)
6. Imune (insulin receptor Abs Hodgkins)
Non-pancreatic neplasms e.g. fibrosarcomas
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9
Q

Investigation for hypoglycaemia

A

72h fast with monitoring

Sympto: lucose, insulin, C-peptide, ketones

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10
Q

Diagnosis of hyperinsulinaemia hypoglycaemia

A
  1. Drugs
    a. increased with C-pep: sulfonylurea
    b. Normal C-pep: insulin
  2. Insulinoma
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11
Q

diagnosis of reduced insulin, no ketones

A
  1. Non-pancreatic neoplasms

2. Insulin receptor antibodies

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12
Q

Diagnosis of reduce insulin and raised ketones

A
  1. Alcohol binge with no food
  2. Pituitary insufficiency
  3. Addisons
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13
Q

Insulinoma path

A

95% benign beta-cell tumour usually seen with MEN1

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14
Q

Insulinoma presentation

A

Fasting/excercise induced hypoglycaemia

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15
Q

Insulinoma investigations

A

hypoglycaemia + raised insulin
Exogenous insulin doesnt suppress C-pep
MRI, EUS pancreas

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16
Q

Insulinoma Rx

A

Excision

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17
Q

Post-prandial hypoglycameia

A

Dumping post-gastric bypass

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18
Q

Post-pandrial hypoglycaemia management if the patient is alert and orientate:

A

Oral Carb

  1. Rapid acitng: lucozade
  2. Long actingL toast, sandwich
19
Q

Post-pandrial hypoglycaemia management if the patient drowsy/confused but swallow intact:

A

Buccal carb
1 Hypostop/Glucoge
2. Consider IV access

20
Q

Post-pandrial hypoglycaemia management if the patient is unconcious or concerned re Swallow

A

IV dextrose

100ml 20% glucose (50ml 50% dextrse: not used)

21
Q

Post-pandrial hypoglycaemia management if the patient is deteriorating/refractory/insulin/no access

A

1mg glucagon IM/SC
Wont work in drunks + short duration of effect (20 mins)
Insulin release may => rebound hypoglycaemia

22
Q

Symptoms

A

Autonomic

Neuroglycopenic

23
Q

Autonomic onset glucose levels onset of symptoms

24
Q

Neuroglycopenic onset of symptoms glucose level

25
Q

Autonomic symptoms

A 
Sweating
Anxiety
Hunger
Tremor
Palpitations
26
Q

Neuroglycopenic

A 
Confusion
Drowsiness
Seqizures
Personality change
Focal neurology (e.g. CN3)
Coma (
27
Q

Fasting hypoglycameia causes: EXPLAIN

A 
Usually insulin or sulfonylurea Rx in a known diabetic - excercise missed meal, OD
1. Exogenous drugs
2. Pituitary insufficiency
3. Liver failure
4. Addison;s
5. Islet cell tumours (insulinomas)
6. Imune (insulin receptor Abs Hodgkins)
Non-pancreatic neplasms e.g. fibrosarcomas
28
Q

Investigation for hypoglycaemia

A

72h fast with monitoring

Sympto: lucose, insulin, C-peptide, ketones

29
Q

Diagnosis of hyperinsulinaemia hypoglycaemia

A
  1. Drugs
    a. increased with C-pep: sulfonylurea
    b. Normal C-pep: insulin
  2. Insulinoma
30
Q

diagnosis of reduced insulin, no ketones

A
  1. Non-pancreatic neoplasms

2. Insulin receptor antibodies

31
Q

Diagnosis of reduce insulin and raised ketones

A
  1. Alcohol binge with no food
  2. Pituitary insufficiency
  3. Addisons
32
Q

Insulinoma path

A

95% benign beta-cell tumour usually seen with MEN1

33
Q

Insulinoma presentation

A

Fasting/excercise induced hypoglycaemia

34
Q

Insulinoma investigations

A

hypoglycaemia + raised insulin
Exogenous insulin doesnt suppress C-pep
MRI, EUS pancreas

35
Q

Insulinoma Rx

36
Q

Post-prandial hypoglycameia

A

Dumping post-gastric bypass

37
Q

Post-pandrial hypoglycaemia management if the patient is alert and orientate:

A

Oral Carb

  1. Rapid acitng: lucozade
  2. Long actingL toast, sandwich
38
Q

Post-pandrial hypoglycaemia management if the patient drowsy/confused but swallow intact:

A

Buccal carb
1 Hypostop/Glucoge
2. Consider IV access

39
Q

Post-pandrial hypoglycaemia management if the patient is unconcious or concerned re Swallow

A

IV dextrose

100ml 20% glucose (50ml 50% dextrse: not used)

40
Q

Post-pandrial hypoglycaemia management if the patient is deteriorating/refractory/insulin/no access

A

1mg glucagon IM/SC
Wont work in drunks + short duration of effect (20 mins)
Insulin release may => rebound hypoglycaemia

41
Q

Fasting causes of hypoglycaemia insulin excess

A
  • Excess exogenous insulin e.g in diabetes mellitus/insulin given surreptitiously
  • Beta-cell tumours/disorders – persistent hypoglycarmia hypersinsulinism in infancy (PHHI, previously called nesidioblastosis), insulinoma
  • Drug induced (sulphonylurea)
  • Autoimmune 9insulin receptor antibodies)
  • Beckwith syndrome
42
Q

Fasting causes of hypoglycaemia Without hyperinsulinanaemia

A
  • Liver disease
  • Ketotic ypoglycaemia of childhood
  • Inborn errors of metabolism e.g. glycogen storage disorders
    Hormonal deficiency: reduced GH, reduced ACTH, ADdisons, congenital adrenal hyperplasia
43
Q

Reactive/non-fasting causes of hypoglycaemia

A
  1. Galactosaemia
  2. Leucine sensitivity
  3. Fructose intolerance
  4. Maternal diabetes
  5. Hormonal deficiency
  6. Aspirin/alcohol poisoning

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