Hypoglycemia

Question 1

Hypoglycemia (clinical signs)

Answer 1

Adrenergic [autonomic] (sweating, shaky, tachycardia, weakness, hunger)
Neuroglycopenic sx (irritability, tremor, seizures, decr consiousness, or coma)

Question 2

Hypoglycemia (Whipple’s Triad)

Answer 2

classic symptoms, low blood glucose, corrected to normal by admin of glucose

Question 3

Hypoglycemia (Labs)

Answer 3

obtain blood and urine BEFORE treatment

Plasma: venous glucose sample

Question 4

Hypoglycemia (precipitants)

Answer 4

fasting, illness, exercise, ingestion of certain sugars (ie galactose or fructose)

Question 5

Presence of ketones separates?

Answer 5

defects in fat oxidation (no ketones)
from
glucose metabolism defects (plus ketones)

Question 6

Obligate glucose utilizers

Answer 6

Brain, renal cortex, RBCs (can’t use ketones in SHORT TERM), but deficient ketone production makes ALL tissues glucose utilizers = hypoglycemia

Question 7

Hypoglycemia Timing (4-6 hrs after eating)

Answer 7

G6Pase defic, milder GSDs in infants and children, hyperinsulinism, cosrtisol and GH defic in infants

Question 8

Hypoglycemia Timing (>6-8 hrs after eating)

Answer 8

cortisol defic and fatty acid oxidation disorders in infants, milder GS and guconeogenc dz, cortisol and GH defic in adults

Question 9

Hypoglycemia Timing (>10-12 hrs after eating)

Answer 9

fatty acid oxidation disorders in older kids and adults, mild disorders of GSD in adults

Question 10

Hypoglycemia Timing (>12-24 hrs after eating)

Answer 10

ketotic hypoglycemia

fatty acid oxidation disorders in older children and adults

Question 11

Deficient Counter Regulatory Hormone

Answer 11

Inc: glucagon, cortisol, epi, growth hormone
HYPOPITUITARISM (cortisol and GH): midline defects, micropenis, undescended tests, jaundice, nystagmus
Adrenal insuff (cortisol): poor growth, hypottension, decr energy

Question 12

Hyperinsulinism

Answer 12

Common in neonate (can be maternal DM, IV glucose to mom during delivery)
Perinatal stress –> treat with diazoxide (Katp channel inhib)
Assoc with 5 protein mutations

Question 13

Infants of DM moms

Answer 13

large for gestational age (macrosomia)
baby secretes high insulin during gestation in reposnse to mom’s high blood sugar, but once baby is born nl gluose but still high insulin leads to HypoG
Classic pres: needs IV glucose AND absence of ketones with serum insulin conc NOT suppressed

Question 14

Ketotic HypoG

Answer 14

15 mo -5 yo, thin undernourished
Usually grow out of it
LACK OF GLUCONEOGENESIS substrates, limited muscle protein
Incr blood and urine KETONES
treat: Ketosticks/juice/glucose containing foods

Question 15

Insulinoma

Answer 15

tumor of endocrine pancreas that makes insulin (assoc MEN-1 in adults)
HIGH c-peptide, low blood sugar, low ketones

Question 16

Insulin overdose

Answer 16

should have low C-peptide

Question 17

Sulfonylurea ingestion

Answer 17

high insulin, high C-peptide

Question 18

EtOH

Answer 18

EtOH –> high NADH –> inhibits gluconeogeneiss and drives procution of lactate (usually in alcoholic who is drinking a lot and not eating carbs)

Question 19

Others

Answer 19

salicylates intox, diarrhea/malnutrition, Dumping syndrome, disorders of aa metabolism etc.