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Endocrine Medicine > Hypoglycaemia > Flashcards

Hypoglycaemia Flashcards

1
Q

Hypoglycaemia is the commonest endocrine emergency.

What constitutes hypoglycaemia?

A
  • < 3 mmol/l
  • Threshold varies
  • 4-8 mmol/l is ‘normal’
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2
Q

Hypoglycaemic features can be divided into autonomic and neuroglycopenic symptoms.

What are autonomic features of hypoglycaemia?

A
  • Sweating
  • Anxiety
  • Hunger
  • Tremor
  • Palpitations
  • Dizziness
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3
Q

What are neuroglycopenic symptoms?

A
  • Confusion
  • Personality changes
  • Drowsiness
  • Visual trouble
  • Seizures
  • Coma
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4
Q

What are causes of hypoglycaemia?

A
  • Most common → insulin or sulphonylurea in diabetics

In non-diabetics, you must EXPLAIN mechanism:

  • Exogenous drugs (eg. insulin, alcohol binge, aspirin poisoning, ACE-i, beta-blockers)
  • Pituitary insufficiency
  • Liver failure
  • Addison’s disease
  • Islet cell tumours (insulinoma)
  • Non-pancreatic neoplasms
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5
Q

What investigations are done for hypoglycaemia?

A
  • Bloods → glucose, insulin, C-peptide and plasma ketones if symptomatic
  • Document BM during attack and lab glucose if in hospital
  • Take a drug history and exclude liver failure
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6
Q

How do you interpret: hypoglycaemic hyperinsulinaemic?

A
  • Insulinoma / Sulfonylureas / Insulin injection
  • C-peptide not detectable (a breakdown product of endogenous insulin)
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7
Q

How do you interpret: low insulin, no excess ketones?

A
  • Non-pancreatic neoplasm
  • Anti-insulin receptor antibodies
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8
Q

How do you interpret: low insulin, excess ketones?

A
  • Alcohol
  • Pituitary insufficiency
  • Addison’s disease
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9
Q

Insulinomas are often benign (90-95%) pancreatic islet cell tumours, sporadic or seen with MEN-1. They present as fasting hypoglycaemia, with Whipple’s triad.

What is Whipple’s triad?

A
  • Symptoms associated w/ fasting or exercise
  • Recorded hypoglycaemia w/ symptoms
  • Symptoms relieved w/ glucose
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10
Q

What is the screening for insulinoma?

A

Hypoglycaemia + increase plasma insulin during a long fast

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11
Q

What is the imaging for insulinoma?

A
  • CT/MRI
  • +/- endoscopic pancreatic USS
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12
Q

What is the management for insulinoma?

A

Excision

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13
Q

What is the management of hypoglycaemia if the patient is: conscious, orientated and able to swallow?

A
  • 15-20g of quick-acting carbohydrate snack (eg. 200ml orange juice)
  • Recheck blood glucose after 10-15mins
  • Repeat snack up to 3 times
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14
Q

What is the management of hypoglycaemia if the patient is: conscious but uncooperative?

A

Squirt glucose gel between teeth and gums

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15
Q

What is the management of hypoglycaemia if the patient is: unconscious or not responding to already mentioned measures?

A
  • IV glucose
  • 10% at 200mL/h if conscious
  • 10% at 200mL/15mins if unconscious
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16
Q

What is the hyperglycaemic hyperosmolar state (HHS)?

A
  • Seen in unwell pts w/ T2DM, typically elderly
  • History is longer than just hypoglycaemia (eg. 1 week)
  • Hyperglycaemia → osmotic diuresis w/ associated loss of Na and K
  • Severe vol depletion → significant raised serum osmolarity (>320) → hyperviscous blood
  • Despite these severe electrolyte losses + total body vol depletion, typical pt w/ HHS may not look as dehydrated as they are bc hypertonicity leads to preservation of intravascular volume
  • There is NO switch to ketone metabolism, so ketonaemia stays < 3mmol/L and pH > 3 (however, can get mixed picture)
17
Q

What are clinical features of hyperglycaemic hyperosmolar state (HHS)?

A
  • General → fatigue, lethargy, N+V
  • Neurological → altered GCS, headaches, papilloedema, weakness
  • Haem → hyperviscosity (MI, stroke)
  • CVS → dehydration, hypotension, tachycardia
18
Q

What is the management of HHS?

A
  • Give LMWH prophylaxis to all unless contraindicated
  • Rehydrate slowly w/ 0.9% NaCl IV / 48 hrs
  • Typical deficits are 110-220ml/kg ie. 8-15L for 70kg adult
  • Replace potassium when urine starts to flow
  • Only use insulin if blood glucose not falling by 5mmol/L/h with rehydration or if ketonaemia
  • Keep BM at least 10-15 mmol/L for first 24h to avoid cerebral oedema

Endocrine Medicine (5 decks)

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