HYPOGLYCEMIA Flashcards
The following together are known as what?
- Blood glucose <70mg/dl
- signs and symptoms of hypoglycemia
a. confusion
b. irritability
c. fatigue
d. anxiety
e. sweating
f. irregular heart rhythm
g. perioral paresthesia - signs and symptoms resolves with glucose elevation
Whipple’s Triad
Symptoms of hypoglycemia begin at plasma glucose levels in the range of ___ and impairment of brain function at approximately ___
- 60mg/dL
2. 50mg/dL
What are the two principal types of spontaneous hypoglycemia in adults?
- fasting
2. postprandial
What type of hypoglycemia is often subacute or chronic and usually presents with neuroglycopenia as its principal manifestations?
Fasting Hypoglycemia
What type of hypoglycemia is relatively acute and is often heralded by symptoms of neurogenic autonomic discharge (sweating, palpitations, anxiety, and tremulousness)? (may been seen in patients after GI surgery)
Postprandial Hypoglycemia
The clinical manifestations of hypoglycemia are are divided into what two broad categories?
- neuroglycopenic
2. sympathomimetic
Neuroglycopenic
As glucose is the main energy source for CNS function, most episodes of symptomatic hypoglycemia include what?
Neurologic dysfunction
Neuroglycopenic
With a decline in serum sugar, the brain quickly exhausts its reserve supply of ____, resulting in CNS dysfunction
carbohydrate fuel
The neuroglycopenic category of hypoglycemia most commonly manifests in what?
- alterations in consciousness
- lethargy
- confusion
- combativeness
- agitation
- unresponsiveness
other manifestations include seizures and focal neuro deficits
A rapid fall in blood glucose levels or the hypothalamic sensing of neuroglycopenia causes the release of the counter-regulatory hormones, primarily the catecholamines epinephrine and norepinephrine is what category of hypoglycemia?
Sympathomimetic
What are the typical symptoms of sympathomimetic hypoglycemia?
- anxiety
- nervousness
- irritability
- nausea
- vomiting
- palpitations
- tremors
Symptoms for hypoglycemia starts at what finger stick blood glucose level?
60mg/dL
Impairment of the brain function starts at what finger stick blood glucose level?
50mg/dL
If considering an auto-immune cause of hypoglycemia what labs should you run?
Serum antibody testing such as:
- GAD-65
- Anti-islet cell
- Anti-insulin antibodies
If considering a surreptitious cause for hypoglycemia what labs should you run?
- C-peptide
- Serial glucose/insulin levels in supervised setting
- Serum sulfonylurea levels
What is caused by a pancreatic B-cell tumor and accidental or surreptitious insulin or sulfonylurea administration?
Hyperinsulinism
True or False
Hypoglycemia
Do not attempt PO interventions on a patient with altered mental status
True
patients are at a high aspiration risk
In patients with hypoglycemia who are unable to eat or drink can be given what?
- Glucagon 0.5 or 1mg SC/IM
2. 50% dextrose 50-100mL IV bolus with or without continuous infusion of 5-10% dextrose solution
Hypoglycemia
Either continued or recurrent mental status alteration, recurrent hypoglycemia, or a downward trend in serial glucose values during observation despite adequate replacement therapy demands what disposition for the patient?
admission to the hospital MEDEVAC
True or False
It is strongly advised to involve the medical officer early in the treatment when the cause for hypoglycemia is not clearly evident
True
What are some complications of hypoglycemia?
- coma
- brain damage
- traumatic injuries (MVA, falls, etc.)
- Death
