Hypoglycaemia
have some emergency haribos.
| Whipple triad: symptomatic, low serum glucose, and resolution of symptoms with glucose. But no universal definition! | |
|---|---|
| History | ➥ Check for precipitants e.g. missed meal, infection ➥ DHx: new drugs that ↓ hypo awareness, recently stopped corticosteroids; change in drug metabolism (renal function, critical illness, major amputation/bariatric surgery) ➥ Concurrent illness e.g sepsis |
| Examination | GCS, focal neurology - hypoglycaemia is a stroke mimic, thyroid status if suspecting hypothyroid |
| Diagnostic investigations | Actual blood glucose, LFTs POC glucose or VBG; renal function ➥ Unexplained hypos: IGF, C-peptide, serum insulin, 3-beta-hydroxybutyrate |
| Immediate management | PO glucose, or IV 100ml 10% (irritant - choose a big cannula), or 1mg IM glucagon (requires normal-ish liver function = glycogen stores) |
| Ongoing management | Review any IV insulin prescriptions |
differentials for underlying pathology
- In the known diabetic:
- ↑ glucose utilisation - exertion, I guess also critical illness
- ↓ glucose delivery - fasting, missed meals
- ↓ endogenous glucose production
- ↓ insulin clearance - renal failure
- In the non-diabetic
- exogenous drugs
- Addisonian crisis, pituitary insufficiency
- Liver disease
- myxoedema coma
- pancreatic tumours- insulinomas