Hypoglycemia   NASRUDDIN BIN ABDUL RAHMAN 2006832992
Investigation  <ul><li>Glucose : < 3.0 mmol/L </li></ul><ul><li>Insulin : any detectable amount is abnormal during hypogly...
<ul><li>Free fatty acids : should be high during fasting and hypoglycemia;  </li></ul><ul><li>low levels suggest hyperinsu...
<ul><li>Toxicology screen : can detect many drugs causing  </li></ul><ul><li>hypoglycemia, especially  </li></ul><ul><li>f...
<ul><li>Glucagon : should be elevated during hypoglycemia,  </li></ul><ul><li>except in the case of type 1 diabetes  </li>...
Management <ul><li>Fully conscious patient </li></ul><ul><li>Oral glucose, sucrose or any sugar containing fluids </li></u...
Prevention is better than cure!! <ul><li>If hypoglycemia recurs at a particular time of day, change the  distribution  and...
Upcoming SlideShare
Loading in …5
×

Hypoglycemia2

1,262 views

Published on

This presentation was present by my friend during emergency posting seminar with Dr.Mohd. Kamal Mohd. Arshad. I upload this ppt here for all of us and my own reference too. Good luck in your life.

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,262
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
32
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Hypoglycemia2

  1. 1. Hypoglycemia NASRUDDIN BIN ABDUL RAHMAN 2006832992
  2. 2. Investigation <ul><li>Glucose : < 3.0 mmol/L </li></ul><ul><li>Insulin : any detectable amount is abnormal during hypoglycemia </li></ul><ul><li>Cortisol : should be high during hypoglycemia if pituitary and </li></ul><ul><li>adrenals are functioning normally </li></ul><ul><li>Growth hormone : should rise after hypoglycemia if pituitary is </li></ul><ul><li>functioning normally </li></ul><ul><li>Electrolytes  and  total carbon dioxide : electrolyte abnormalities may suggest renal or adrenal disease; mild acidosis is normal with starvation hypoglycemia </li></ul><ul><li>Liver enzymes : elevation suggests liver disease </li></ul><ul><li>Ketones : should be high during fasting and hypoglycemia; low levels </li></ul><ul><li>suggest hyperinsulinism or fatty acid oxidation disorder </li></ul>
  3. 3. <ul><li>Free fatty acids : should be high during fasting and hypoglycemia; </li></ul><ul><li>low levels suggest hyperinsulinism; high with low </li></ul><ul><li>ketones suggests fatty acid oxidation disorder </li></ul><ul><li>Lactic acid : high levels suggest sepsis or an inborn error of </li></ul><ul><li>gluconeogenesis such as glycogen storage disease </li></ul><ul><li>Ammonia : if elevated suggests hyperinsulinism due to glutamate </li></ul><ul><li>dehydrogenase deficiency, Reye syndrome, or certain </li></ul><ul><li>types of liver failure </li></ul><ul><li>C-peptide : should be low or undetectable; if elevated suggests </li></ul><ul><li>hyperinsulinism; low c-peptide with high insulin suggests </li></ul><ul><li>exogenous (injected) insulin </li></ul><ul><li>Proinsulin : detectable levels suggest hyperinsulinism; levels </li></ul><ul><li>disproportionate to a detectable insulin level suggest insulinoma </li></ul><ul><li>Ethanol : suggests alcohol intoxication </li></ul>
  4. 4. <ul><li>Toxicology screen : can detect many drugs causing </li></ul><ul><li>hypoglycemia, especially </li></ul><ul><li>for sulfonylureas </li></ul><ul><li>Insulin antibodies : if positive suggests repeated insulin injection or </li></ul><ul><li>antibody-mediated hypoglycemia </li></ul><ul><li>Urine organic acids : elevated in various characteristic patterns in </li></ul><ul><li>several types of organic aciduria </li></ul><ul><li>Carnitine , free and total: low in certain disorders of fatty acid </li></ul><ul><li>metabolism and certain types of drug </li></ul><ul><li>toxicity and pancreatic disease </li></ul><ul><li>Thyroxine  and  TSH : low T4 without elevated TSH </li></ul><ul><li>suggests hypopituitarism or malnutrition </li></ul><ul><li>Acylglycine : elevation suggests a disorder of fatty acid oxidation </li></ul><ul><li>Epinephrine : should be elevated during hypoglycemia </li></ul>
  5. 5. <ul><li>Glucagon : should be elevated during hypoglycemia, </li></ul><ul><li>except in the case of type 1 diabetes </li></ul><ul><li>mellitus where irreparable damage is done to the cells </li></ul><ul><li>which produce this counterregulatory hormone. </li></ul><ul><li>IGF-1 : low levels suggest hypopituitarism or chronic malnutrition </li></ul><ul><li>IGF-2 : low levels suggest hypopituitarism; high levels suggest non- </li></ul><ul><li>pancreatic tumor hypoglycemia </li></ul><ul><li>ACTH : should be elevated during hypoglycemia; unusually high </li></ul><ul><li>ACTH with low cortisol suggests Addison's disease </li></ul><ul><li>Alanine  or other plasma  amino acids : </li></ul><ul><li>abnormal patterns may suggest certain inborn errors of amino acid metabolism or gluconeogenesis </li></ul><ul><li>Somatostatin  : should be elevated during hypoglycemia as it acts to </li></ul><ul><li>inhibit insulin production and increase blood glucose </li></ul><ul><li>level </li></ul>
  6. 6. Management <ul><li>Fully conscious patient </li></ul><ul><li>Oral glucose, sucrose or any sugar containing fluids </li></ul><ul><li>Patients mental function impaired </li></ul><ul><li>IV 50% dextrose 25-50ml or as much as possible until patient mental state recover. </li></ul><ul><li>If hypoglycemia is caused by long acting insulin or OHA, continue 10% dextrose drip for 24-48 hrs </li></ul><ul><li>Glucagon, 1mg IM or SC can be given to treat severe hypoglycemia if IV access is difficult. </li></ul><ul><li>Patient who remain unconscious after prolong hypoglycemia may need to be given treatment for cerebral edema with IV dexamethasone 4mg 6hrly or IV mannitol. </li></ul>
  7. 7. Prevention is better than cure!! <ul><li>If hypoglycemia recurs at a particular time of day, change the distribution and timing of insulin injection. </li></ul><ul><li>If hypoglycemia is severe, prolonged, or unpredictable, adjust the dosage . </li></ul><ul><li>Increase the carbohydrate intake prior to increase or prolonged activity </li></ul><ul><li>Avoid long acting sulfonylureas like glibenclamide in elderly patient and patient with renal failure. </li></ul>

×