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HYPOGLYCEMIA and its complications and ita mechanism.pptx
- 1. HYPOGLYCEMIA MENTOR : Dr. Gunaseelan PRESENTOR : Dr. K. Rahini
- 2. CONTENTS • DEFINITION • PATHOPHYSIOLOGY • CAUSES • CLINICAL FEATURES • NEUROGLYCOPENIC HYPOGLYCEMIA • AUTONOMIC HYPOGLYCEMIA • DIAGNOSIS • TREATMENT • PEDIATRIC HYPOGLYCEMIA
- 3. DEFINITION • Hypoglycemia is characterized by a reduction in plasma glucose concentration (<70mg/dl) or to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system stimulation
- 5. CAUSES Medicated individual Drugs Critical illness Hormone deficiency Non-islet tumor Insulin/OHA Insulin secretagogues Alcohol Hepatic failure Renal failure Cardiac failure Sepsis Cortisol Growth Hormone Glucagon and Epinephrine
- 6. Seemingly well individual Endogenous hyperinsulinis m Gluconeogene sis and Fatty acid oxidation Exercise Accidental Surreptitious Malicious Insulinoma Functional Beta cell disorders Insulin autoimmune hypoglycemia
- 7. CLINICAL FEATURES • NEUROGLYCOPENIC MANIFESTATIONS : Result of CNS glucose deprivation Behavioural change Confusion Fatigue Seizure LOC Cardiac arrythmias
- 8. AUTONOMIC MANIFESTATIONS • Result from perception of physiologic changes caused by CNS mediated sympathoadrenal discharge triggered by hypoglycemia
- 11. DIFFERENTIAL DIAGNOSIS • Stroke/ TIA • Seizure disorder • Traumatic head injury • Brain tumor • Narcolepsy • Multiple sclerosis • Psychosis/Hysteria/ Depression • Sympathomimetic drug ingestion • Altered sleep patterns and nightmares
- 12. TREATMENT • Mild symptoms : Oral glucose • With AMS : 50% Dextrose in water IV Bolus Repeat after 15 minutes if hypoglycemia persists When Blood glucose reaches 70mg/dl and regains consciousness continue oral • IV Dextrose infusion : If blood glucose normalized but patient remains unconscious • Check blood glucose every 30 minutes • Failure to respond consider other causes
- 13. • Glucagon : 1mg SC/IM Not recommended in Heavy alcohol users , Marathon runners, Sulfonylureas induced hypoglycemia • Sulfonylureas induced : Octreotide • Refractory Sulfonylureas induced hypoglycemia : Diazoxide
- 15. DEFINITION • Blood glucose concentration < 47mg/dl • It also includes any glucose concentration low enough to cause signs or symptoms of impaired brain function • Severe hypoglycemia : <36mg/dl • Recurrent hypoglycemia : 3 or more episodes • Transient neonatal hypoglycemia : Within 48 hours of birth
- 17. EVALUATION
- 18. TREATMENT • Dextrose is the primary treatment Dose : 0.5-1.0g/kg • Newborn : 5mL/kg of 10% Dextrose • Infants and children can receive 1 to 2mL/kg of 25% Dextrose • Maintenance Dextrose : 6-8mg/kg/min with 10% Dextrose
- 19. Suspected Adrenal insufficiency : Inj.Hydrocortisone NEONATES 25g IV/IM TODDLERS SCHOOL AGED CHILDREN 50g ADOLESCENT 100g
- 20. MANAGEMENT OF HYPOGLYCEMIA IN ED
- 21. REFERENCES • TINTINALLI’S 9TH EDITION • ROSEN’S 10TH EDITION • HARRISON’S 21ST EDITION