Hypoglycemia

Question 1

What is the definition of hypoglycemia?

Answer 1

Reduced plasma glucose concentration which in the healthy adult equates to a plasma glucose below 3mmol/L (55mg/dL)

Question 2

What is a normal fasting glucose?

Answer 2

5 to 7.2 mmol/L (70 - 130 mg/dL)

Question 3

What are the clinical features of hypoglycemia?

Answer 3

1. SNS activation - diaphoresis, tremor, tachycardia, anxiety, hunger
2. Neuroglycopenic - weakness, fatigue, altered MS, coma

Question 4

What is the differential diagnosis of hypoglycemia?

Answer 4

1. Exogenous insulin
2. Critical illness - sepsis
3. Endocrine (Addison, adrenal crisis, hypopituitarism)
4. Insulin-producing tumors
5. Fasting
6. Reactive (postprandial) hypoglycemia - idiopathic or enzyme deficiencies

Question 5

What are the causes of reactive hypoglycemia?

Answer 5

Reactive or postprandial hypoglycemia is often idiopathic or caused by enzyme deficiencies.

Question 6

What are endocrine causes of hypoglycemia?

Answer 6

Addison disease
Adrenal crisis
Hypopituitarism

Question 7

What conditions can cause/are associated with “fasting” hypoglycemia?

Answer 7

inherited liver/fatty acid oxidation enzyme deficiencies

drugs - ethanol, haloperidol

Question 8

What drugs are associated with “fasting” hypoglycemia?

Answer 8

ethanol, haloperidol

Question 9

What is the management of hypoglycemia?

Answer 9

1. Confirm glucose level
2. Supplement with oral sugars or IV dextrose
3. History and physical exam to assess for underlying cause
4. Continue to monitor glucose levels until stable