Hypoglycemia Flashcards
What is Whipple’s Triad
a) Blood glucose measured at <70mg/dl
(b) Clinical signs and symptoms of hypoglycemia (confusion, irritability, fatigue, anxiety, sweating, irregular heart rhythm, perioral paresthesia)
(c) Clinical signs and symptoms resolve with appropriate glucose elevation
Symptoms for hypoglycemia begin at plasma glucose levels in the range of ___ mg/dL and impairment of brain function at approximately ___ mg/dL.
60 mg/dL
50mg/dL
Spontaneous hypoglycemia in adults is of what two principal types?
-fasting
-postprandial
Fasting hypoglycemia is often subacute or chronic and usually presents with _________ as its principal manifestation.
neuroglycopenia
What type of hypoglycemia is relatively acute and is often heralded by symptoms of neurogenic autonomic discharge (sweating, palpitations, anxiety, and tremulousness)
-May be seen in patient after gastrointestinal surgery
Postprandial hypoglycemia
Signs and symptoms of what issue?
Patients with this may have a wide array of symptoms and signs.
(2) The clinical manifestations are divided into two broad categories: neuroglycopenic and sympathomimetic.
(a) Neuroglycopenic
–1) As glucose is the main energy source for CNS function, most episodes of symptomatic hypoglycemia include neurologic dysfunction.
–2) With a decline in serum sugar, the brain quickly exhausts its reserve supply of carbohydrate fuel, resulting in CNS dysfunction.
–3) This manifests most commonly by alterations in consciousness, lethargy, confusion, combativeness, agitation, and unresponsiveness.
–4) Other neuroglycopenic manifestations include seizures and focal neurologic deficit
(b) Sympathomimetic
–1) 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.
—-a) Typical symptoms include anxiety, nervousness, irritability, nausea, vomiting, palpitations, and tremor
hypoglycemia
Labs If considering auto-immune
Serum antibody testing such as:
GAD-65, anti-islet cell, and anti-insulin antibodies
Labs if considering surreptitious cause
C-peptide, serial glucose/insulin levels in supervised setting, serum
sulfonylurea levels
Differential Diagnosis for hypoglycemia
–Hyperinsulinism: Pancreatic B-cell tumor and accidental or surreptitious insulin orsulfonylurea administration.
–Extra-pancreatic tumors
– Postprandial hypoglycemia: early hypoglycemia (alimentary)
Treatment for Hypoglycemia if able to tolerate PO
drink juices, sucrose water, or glucose solutions; eat candy or other foods; or chew on glucose tablets when symptoms occur.
Immediate treatment of hypoglycemia involves provision of _____
Glucose
Do not attempt PO interventions on a patient with altered mental status why?
high aspiration risk
Treatment for hypoglycemia
Adults unable to eat or drink can be given what?
-glucagon 0.5 or 1 mg SC/IM
or
-50% dextrose 50 to 100 mL IV bolus
with or without
a continuous infusion of 5 to 10% dextrose solution sufficient to resolve symptoms
After initial treatment Once patients are alert and safe to do so, they should do what?
consume a meal (containing
carbohydrates, proteins, and fats) to prevent immediate hypoglycemia recurrence.
DISPOSITION 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….
admission to the hospital MEDEVAC
