By Ahmad soliman abdul halim

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Presentation transcript:

By Ahmad soliman abdul halim Hypoglycemia By Ahmad soliman abdul halim

Definition

Definition of hypoglycemia Infant & child : < 47 mg/dl

pathophysiology

Pathophysiology In Fed State : ↑glucose→↑insulin secretion → ↑ glucose uptake into cells Suppress lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis In fast state : ↓glucose→↓insulin secretion → ↑ lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis With help of hormones

Causes

CAUSES & CLASSIFICATION OF HYPOGLYCEMIA Hyperinsulinemia (Negtive ketones) Non Hyperinsulinemia state (Postive ketones) Idm Psih Presistent Hyperinulinemia Insulinoma Induced Gluconeogensis & glycogen storage defect Faod Hormonal :gh & cortisol Drugs Idiopathic

Causes of hypoglycemia (HYPERINSULINISM) HYPERINSULINISM (No ketonuria) IDM PSIH Congenital hyperinsulinism Insulinoma BWS Factitious

Causes of hypoglycemia (HYPERINSULINISM) HYPERINSULINISM (No ketonuria) Congenital hyperinsulinism Beckwith-Wiedemann Syndrome

Causes of hypoglycemia ( NON HYPERINSULINISM) Gluconeogenesis & glycogen storage defect (ketonuria) GSD I,III,IV,IX Fructose 1,6 Diphosphatase Pyruvate carboxlyse Galactosemia

Causes of hypoglycemia ( NON HYPERINSULINISM) Gluconeogenesis & glycogen storage defect (ketonuria) glycogen storage defect

Causes of hypoglycemia ( NON HYPERINSULINISM) Fatty acid oxidation defect Ketogensis defect (No ketonuria)

Causes of hypoglycemia ( NON HYPERINSULINISM) Hypopituitarism Addison Hormonal defect ( ketonuria)

Causes of hypoglycemia ( NON HYPERINSULINISM) Drug induced (ketonuria)

Causes of hypoglycemia ( NON HYPERINSULINISM) Ketotic hypoglycemia

Clinical

Clinical picture of Hypoglycemia

approach

CLINICAL APPROACH 1 4 2 is the case in acute attack or not? 3 Confirm The Diagnosis Of Hypoglycemia By Lab Or History Of Proved Pervious Attacks 2 is the case in acute attack or not? 3 How to deal with the case in between acute attack? review your collected data 4

How to deal with case with acute attack? Obtain Urine Or Blood Sample For Ketones,ABG Ketones present , Acidosis : suspect Hormonal deficiency Gluconeogensis & glycogen defects Ketotic (idiopathic hypoglycemia) IF YOU CAN DO THIS GO TO THE NEXT STEP Ketones absent, normal ABG: suspect hyperinsulinism or FAOD Try to obtain serum insulin(<5,100uU/ML) , if not elevated review metabolic screen ,if negative review extended metabolic screen Obtain serum cortisol & GH, lactate (10,5ug/dl)

1 2 3 How to deal with case NOT IN acute attack? Careful history for Symptoms in relation to meals Drug history Other neurological symptoms Salt craving Family history of unexplained sibling death 2 Examine for Stature Skin pigmentation Hepatomegally Neurological examination 3 Admit to hospital for provocative tests 24hrs fast under careful observation: when symptoms provoked , proceed as step 2

Review your data Postive routine or EMS for FFA Elevated serum insulin KETONES IN URINE OR BLOOD , ACIDOSIS NO KETONES IN URINE OR BLOOD , NORMAL ABG Postive routine or EMS for FFA Elevated serum insulin Elevated lactate Normal lactate >5uu >100uu Exogenous hyperinsulinism Endogenous hyperinsulinism Enzyme study + liver biopsy Hormonal assay (negative) Enzyme study + liver biopsy Ketotic hypoglycemia is diagnosis of exclusion Drug review Rview onset Image if insulinoma

treatment

TREATMENT