Transcript Hypoglycemia - Cleveland Clinic

Hypoglycemia
Jane DisaSmith, D.O
Dec. 13, 2005
Slides by Billie Hall, D.O.
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
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
Clinical Features
• Common scenario in DM pt’s include
inadequate food intake, incorrect dosing of
meds, increased physical exertion
• Patient’s may have a wide range of
symptoms and sign: lethargy, change in
mental status, agitaton, combativeness
and even seizures
Clinical Features
• Rapid fall may cause release of
counterregulatory hormones such as epi,
causing nervousness, anxiety, nausea and
vomiting, palpitations and tremor
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
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
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
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.
Treatment
• Thiamine 100mg should be given as well
as glucose without thiamine in nutritionally
deficient pt’s could precipitate Wernicke’s
encephalopathy.
Admission
• Table 210-2 has a set of guidelines for
admission to the hospital for any patient
that presents as hypoglycemic
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
don’t have to worry about giving anything else in
the alcoholic/nutritionally deficient patient. T or
F
• T, F – must give Thiamine as well