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Hypoglycemia

Hypoglycemia is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • Deficiency in counterregulatory hormones (glucagon, epinephrine, cortisol, growth hormone) or excessive insulin response
  • Serum glucose < 70 mg/dL

Risk Factors

  • Strict glycemic control with insulin
  • Prior hypoglycemia episodes
  • Hypoglycemia unawareness
  • Decreased counterregulation
  • <5 years of age or elderly
  • Comorbid conditions:
    • Renal disease
    • Malnutrition
    • Coronary artery disease
    • Liver disease

Genetics
  • Congenital metabolic and endocrine disorders that decrease gluconeogenic ability (e.g., hereditary fructose intolerance)
  • Congenital hyperinsulinism
  • Neonatal diabetes mellitus (often a mutation effecting an ATP-dependent potassium channel)

Etiology

  • Increased insulin levels:
    • Overdose of oral hypoglycemic agent or insulin
    • Oral antihyperglycemics (i.e., α-glucosidase inhibitors, biguanides, and thiazolidinediones) do not cause hypoglycemia alone, but may enhance the risk when used with insulin or sulfonylureas.
    • Sepsis
    • Insulinoma
    • Autoimmune hypoglycemia
    • Alimentary hyperinsulinism
    • Renal failure (partially responsible for insulin metabolism)
    • Liver cirrhosis (responsible for significant insulin metabolism)
  • Underproduction of glucose:
    • Alcohol (inhibitory effect on glycogen storage and gluconeogenesis)
    • Drugs
    • Salicylates
    • β-blockers (including eye drops)
    • SSRIs
    • Some antibiotics (e.g., sulfonylureas, pentamidine)
    • Adrenal insufficiency
    • Malnutrition
    • Dehydration
  • Cerebral edema
  • Extremes of age
  • Congestive heart failure
  • Counterregulatory hormone deficiency
  • Hypothyroidism or hyperthyroidism

Pregnancy Considerations
  • 3rd-trimester pregnant patients risk relative substrate deficiency–induced hypoglycemia.
  • The fetus is less likely to become hypoglycemic during mother's hypoglycemic episode secondary to active glucose transport across placenta:
    • Oral hypoglycemic use in pregnancy may lead to profound and prolonged neonatal hypoglycemia.


Pediatric Considerations
Most common cause of hypoglycemia in the 1st 3 mo of life is persistent hyperinsulinemic hypoglycemia of infancy (PHHI) in mothers with diabetes.

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Citation

Rosen, Peter, et al., editors. "Hypoglycemia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia.
Hypoglycemia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia. Accessed April 25, 2019.
Hypoglycemia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia
Hypoglycemia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hypoglycemia ID - 307435 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307435/all/Hypoglycemia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -