Hypoglycemia

Himawan Sanusi
Internal Medicine
University of Hasanuddin
Makassar
 Hypoglycemia
O Defined as serum glucose less than 50-60 mg/dL

O Hypoglycemia is cause of 7% of people arriving to

ED for change in mental status

O Glucose is an obligate metabolic fuel for the brain.

Pathophysiology
O First defense is decrease in insulin secretion
O Glucagon and epinephrine then stimulate
hepatic glucose production
O Glycogen reserve is limited and and will be
depleted after 24-48 hours of fasting
O With continued fasting, gluconeogenesis
becomes primary source of glucose
Sign and symptoms of Hypoglycemia
 Clinical Features of Hypoglycemia
Symptoms
O Autonomic :
O adrenergic: palpitations, tremor, and anxiety;
O cholinergic: sweating, hunger, and
paresthesia)
O Neuroglycopenic (behavioral changes, confusion,
fatigue, seizure, loss of consciousness,
O severe and prolonged death
Sign :
O Tachycardia, elevated systolic blood pressure,
pallor, and diaphoresis may be present
Etiology of hypoglycemia
1. Drugs: insulin, insulin secretagogues, alcohol, high doses of
salicylates, sulfonamides, pentamidine, quinine, quinolones
2. Critical illness : hepatic, renal, cardiac failure; sepsis;
and prolonged starvation
3. Hormone deficiencies : adrenal insufficiency, hypopi
tuitarism
4. Insulinoma: pancreatic, cell tumor, cell hyperplasia
(a.k.a. nesidioblastosis; congenital or after gastric or bariatric
surgery)
5. Other rare etiologies: Non- cell tumors (large
mesenchymal or epithelial tumors producing IGF-II, other non-
pancreatic tumors), insulin or insulin receptor antibodies,
inherited enzymatic defects
 Hypoglycemia in DM
,

inadequate food intake

incorrect dosing of meds

increased physical exertion

 Diagnosis
O Blood glucose should be drawn at the time of
symptoms, whenever possible before the
administration of glucose,

O Should always be considered with altered mentation

O Rapid bedside testing should be performed on all

patients that present as stroke, TIA, seizure disorder,
narcolepsy, psychosis
 Treatment
O 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.

O Oral replacement is best. 300 grams of carbs

should be given PO as soda, crackers, juices
 Treatment
O Oral replacement is best. 300 grams of carbs
should be given PO as soda, crackers, juices

O Acute therapy of hypoglycemia requires

administration of oral glucose or 25 g of a 50%
solution IV followed by a constant infusion of 5 or
10% dextrose

O Hypoglycemia from sulfonylureas is often prolonged,

requiring treatment and monitoring for 24 h or more