Transcript Causes of hypoglycemia

HYPOGLYCEMIA
BY
AHMAD SOLIMAN ABDUL HALIM
D E F I N I T I O N
DEFINITION OF HYPOGLYCEMIA
Infant & child : < 47 mg/dl
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Pathophysiology
In Fed State :
↑glucose→↑insulin secretion → ↑ glucose uptake into cells
Suppress lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis
In fast state :
↓glucose→↓insulin secretion → ↑ lipolysis , gluconeogenesis
,glycogenolysis & ketogenesis With help of hormones
C A U S E S
CAUSES & CLASSIFICATION OF HYPOGLYCEMIA
Hyperinsulinemia
NON HYPERINSULINEMIA STATE
(Negtive ketones)
(POSTIVE KETONES)
• IDM
• GLUCONEOGENSIS & GLYCOGEN STORAGE
DEFECT
• PSIH
• Presistent Hyperinulinemia
• Insulinoma
• Induced
• FAOD
• HORMONAL :GH & CORTISOL
• DRUGS
• IDIOPATHIC
Causes of hypoglycemia
(HYPERINSULINISM)
HYPERINSULINISM
(No ketonuria)
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IDM
PSIH
Congenital hyperinsulinism
Insulinoma
BWS
Factitious
Causes of hypoglycemia
(HYPERINSULINISM)
HYPERINSULINISM
(No ketonuria)
Congenital hyperinsulinism
Beckwith-Wiedemann Syndrome
Causes of hypoglycemia
( NON HYPERINSULINISM)
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GSD I,III,IV,IX
Fructose 1,6 Diphosphatase
Pyruvate carboxlyse
Galactosemia
Causes of hypoglycemia
( NON HYPERINSULINISM)
Gluconeogenesis & glycogen storage defect
(ketonuria)
glycogen storage defect
Causes of hypoglycemia
( NON HYPERINSULINISM)
• Fatty acid oxidation defect
Causes of hypoglycemia
( NON HYPERINSULINISM)
Hormonal defect
( ketonuria)
• Hypopituitarism
• Addison
Causes of hypoglycemia
( NON HYPERINSULINISM)
Causes of hypoglycemia
( NON HYPERINSULINISM)
Ketotic hypoglycemia
C L I N I C A L
Clinical picture of Hypoglycemia
A P P R O A C H
CLINICAL APPROACH
1
Confirm The Diagnosis Of Hypoglycemia
By Lab Or History Of Proved Pervious Attacks
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is the case in acute attack or not?
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How to deal with the case in between acute attack?
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review your collected data
How to deal with case with acute attack?
Obtain Urine Or Blood Sample For Ketones,ABG
Ketones absent, normal ABG:
suspect
hyperinsulinism or FAOD
Try to obtain serum
insulin(<5,100uU/ML) , if
not elevated review
metabolic screen ,if
negative review extended
metabolic screen
IF YOU CAN
DO THIS GO
TO THE NEXT
STEP
Ketones present , Acidosis :
suspect
• Hormonal deficiency
• Gluconeogensis & glycogen defects
• Ketotic (idiopathic hypoglycemia)
Obtain serum cortisol & GH, lactate
(10,5ug/dl)
How to deal with case NOT IN acute attack?
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Careful history for
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Symptoms in relation to meals
Drug history
Other neurological symptoms
Salt craving
Family history of unexplained sibling death
Examine for
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Stature
Skin pigmentation
Hepatomegally
Neurological examination
Admit to hospital for provocative tests
24hrs fast under careful observation: when symptoms provoked , proceed as step 2
REVIEW YOUR DATA
KETONES IN URINE OR BLOOD ,
ACIDOSIS
Elevated lactate
Normal lactate
NO KETONES IN URINE OR
BLOOD , NORMAL ABG
Postive routine
or EMS for FFA
Elevated serum
insulin
>5uu
Endogenous
hyperinsulinism
Enzyme study + liver
biopsy
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Hormonal assay (negative)
Enzyme study + liver biopsy
Ketotic hypoglycemia is diagnosis of exclusion
• Rview onset
• Image if insulinoma
>100uu
Exogenous
hyperinsulinism
Drug
review
T R E A T M E N T
TREATMENT