Monday, June 4, 2012

Signs and Symptoms of Hypoglycemia







An approach to patient with hypoglycaemia


Whipple’s triad
  1. ·         SSx consistent with hypoglycaemia
  2. ·         Documented glucose level low
  3. ·         Treatment given causes SSx resolves

Definition of hypoglycaemia:
  • For healthy individual DXT < 3.0 mmol/L
  • For DM patient DXT < 3.8 mmol/L


SSx
Autonomic (peripheral NS)
Shaking, trembling, sweating, palpitation, hunger, pins and needles in lips and tongue etc.
Neuroglycopenic (CNS)
Confuse, anxiety, couldn’t concentrate, abnormal mental state, irritable, focal neurological signs, impaired vision etc.

Precipitating causes

1]        Underlying liver or renal diseases (source of gluconeogenesis)

2]        OHA
             § Glibenclamide à used more in KK, higher risk of hypoglycaemia than others because it has               more prolonged action
            § Gliclazide
            § Metformin

3]         Cortisol deficiency

4]         Insulinoma etc

Management

1.      Withhold all OHA or insulin.

2.     If mental functions intact and tolerating orally, give 15g carbohydrates
  • ·                              1-2 tablets of glucose/sweet
  • ·                              3 teaspoon of sugar
  • ·                             1-2 cups of milk, orange juice
  • ·                             Pieces of fruits
  • ·                            3 pcs of crackers
  • ·                           1-2 pcs of bread/sandwich
3.      Repeat DXT after 15 min. If still <3.9, give another 15g carb.      

4.       If minimal hypo, could not tolerate orally à give 30-50cc D50% then repeat DXT monitoring

5.      If persistently hypo (usually due to OHA) à give 50cc D50% + 25g Carb + IV 1 pint D10% /    24hrs

6.      To consider IM glucagon if difficult IV access, once regain consciousness, to encourage orally

7.       For pt who remain unconscious due to prolonged hypoglycaemia, start IV Dexa 4mg QID or             IV Mannitol to treat cerebral oedema, and find out other causes of coma (drug overdose or stroke)

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