1. Hypoglycemia Jane DisaSmith, D.O Dec. 13, 2005 Slides by Billie Hall, D.O.

2. Hypoglycemia Defined as serum glucose less than 50-60 mg/dL Hypoglycemia is cause of 7% of people arriving to ED for change in mental status

3. Pathophysiology First defense is decrease in insulin secretion Glucagon and epinephrine then stimulate hepatic glucose production Glycogen reserve is limited and and will be depleted after 24-48 hours of fasting With continued fasting, gluconeogenesis becomes primary source of glucose

4. Clinical Features Common scenario in DM pt’s include inadequate food intake, incorrect dosing of meds, increased physical exertion Patient’s may have a wide range of symptoms and sign: lethargy, change in mental status, agitaton, combativeness and even seizures

5. Clinical Features Rapid fall may cause release of counterregulatory hormones such as epi, causing nervousness, anxiety, nausea and vomiting, palpitations and tremor

6. Diagnosis Should always be considered with altered mentation Rapid bedside testing should be performed on all patients that present as stroke, TIA, seizure disorder, narcolepsy, psychosis

7. Treatment Initial mgt is admin of 1 g/kg body weight of dextrose as D50W in adults. This can be followed by D10W at a rate ot maintain glucose 100mg/dL or more. Oral replacement is best. 300 grams of carbs should be given PO as soda, crackers, juices

8. Treatment Glucagon 1mg IM or IV can be given if no IV access. But beware, this can take longer than IV glucose, and the condition of alcoholics, elderly and others with depleted glycogen stores will generally not improve with Glucagon

9. Treatment Octreotide has been used for treatment of sulfonylurea induced hypoglycemia Administered SQ with initial dose of 50 to 125 mcg. Only recommended after initial glucose therapy has been initiated.

10. Treatment Thiamine 100mg should be given as well as glucose without thiamine in nutritionally deficient pt’s could precipitate Wernicke’s encephalopathy.

11. Admission Table 210-2 has a set of guidelines for admission to the hospital for any patient that presents as hypoglycemic

12. Questions 1. Any change of mental status that presents to the ER must have their glucose checked. T or F 2. As long as you are giving the glucose, you don’t have to worry about giving anything else in the alcoholic/nutritionally deficient patient. T or F T, F – must give Thiamine as well