CURRENT Essentials of Critical Care.pdf

Chapter 12 Endocrine Problems 183■■■HypoglycemiaEssentials of Diagnosis• Plasma glucose 45 mg/dL• Sweating, trembling, feeling of warmth, palpitations, anxiety,nausea, hunger, blurred or double vision, weakness• Neuroglycopenic symptoms with prolonged hypoglycemia:dizziness, confusion, tiredness, difficulty speaking, headache,inability to concentrate, nightmares, bizarre behavior• Clinical diagnostic criteria for insulinoma (Whipple triad): hypoglycemicsymptoms in fasting or exercising state, low plasmaglucose level, relief of symptoms through correction of hypoglycemia• Insulin and C-peptide levels may help determine cause• In nondiabetic hospitalized patients common etiologies includerenal insufficiency, malnutrition, liver disease, infection, sepsis• Other causes: alcoholism, adrenal insufficiency, medications(insulin, sulfonylurea, pentamidine, trimethoprim-sulfamethoxazole,salicylates, beta-blocking agents), insulin-secreting tumorsDifferential Diagnosis• Delirium • Psychoneurosis• Pheochromocytoma • Sepsis syndrome• Factitious hypoglycemia • Myxedema coma• Liver failureTreatment• Administer glucose intravenously or orally (if awake and alert)• Monitor blood glucose closely as patient may need continuousdextrose infusion until precipitating cause removed• Glucagon and hydrocortisone can be given for refractory hypoglycemia• Identify and treat underlying disease or remove causative agent■ PearlBecause the liver and kidneys are the primary organs involved in themetabolism of insulin and the sulfonylurea drugs, development of renalor hepatic failure may delay drug clearance and result in hypoglycemia.ReferenceService FL: Hypoglycemic disorders. N Engl J Med 1995;332:1144. [PMID:7700289]