Hypoglycemia

1
Hypoglycemia

• Jane DisaSmith, D.O
• Dec. 13, 2005
• Slides by Billie Hall, D.O.

2
Hypoglycemia

• Defined as serum glucose less than 50-60 mg/dL
• Hypoglycemia is cause of 7 of people arriving to
  ED for change in mental status

3
Pathophysiology

• First defense is decrease in insulin secretion
• Glucagon and epinephrine then stimulate hepatic
  glucose production
• Glycogen reserve is limited and and will be
  depleted after 24-48 hours of fasting
• With continued fasting, gluconeogenesis becomes
  primary source of glucose

4
Clinical Features

• Common scenario in DM pts include inadequate
  food intake, incorrect dosing of meds, increased
  physical exertion
• Patients may have a wide range of symptoms and
  sign lethargy, change in mental status,
  agitaton, combativeness and even seizures

5
Clinical Features

• Rapid fall may cause release of counterregulatory
  hormones such as epi, causing nervousness,
  anxiety, nausea and vomiting, palpitations and
  tremor

6
Diagnosis

• Should always be considered with altered
  mentation
• Rapid bedside testing should be performed on all
  patients that present as stroke, TIA, seizure
  disorder, narcolepsy, psychosis

7
Treatment

• Initial mgt is admin of 1 g/kg body weight of
  dextrose as D50W in adults. This can be followed
  by D10W at a rate ot maintain glucose 100mg/dL or
  more.
• Oral replacement is best. 300 grams of carbs
  should be given PO as soda, crackers, juices

8
Treatment

• Glucagon 1mg IM or IV can be given if no IV
  access. But beware, this can take longer than IV
  glucose, and the condition of alcoholics, elderly
  and others with depleted glycogen stores will
  generally not improve with Glucagon

9
Treatment

• Octreotide has been used for treatment of
  sulfonylurea induced hypoglycemia
• Administered SQ with initial dose of 50 to 125
  mcg.
• Only recommended after initial glucose therapy
  has been initiated.

10
Treatment

• Thiamine 100mg should be given as well as glucose
  without thiamine in nutritionally deficient pts
  could precipitate Wernickes encephalopathy.

11
Admission

• Table 210-2 has a set of guidelines for admission
  to the hospital for any patient that presents as
  hypoglycemic

12
Questions

• 1. Any change of mental status that presents to
  the ER must have their glucose checked. T or F
• 2. As long as you are giving the glucose, you
  dont have to worry about giving anything else in
  the alcoholic/nutritionally deficient patient. T
  or F
• T, F must give Thiamine as well