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Hypoglycemia - Don't Get Fooled!!

7/3/2014

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PictureDr. Fox
HYPOGLYCEMIA
Presentation:
  • Classic Hypoglycemia Symptoms = Both autonomic and neuroglycopenic symptoms
  • Autonomic = catecholamine release -> tremor, tachycardia, and diaphoresis.
  • Neuroglycopenic -> confusion, Seizures, and coma
  • Many pts do not present in the “classic” fashion.
  • Interestingly - Can actually present with FOCAL Neurologic deficit… SO CHECK GLUCOSE BEFORE CALLING CODE STROKE!!

Not all patients recognize their own hypoglycemia well.
  • Often we get used to diabetics stating that they think their sugar is low.
  • Unfortunately, they may not perceive their own level well.
  • Additionally, they may have symptoms at “normal-low” levels.
  • Poorly controlled diabetics first developed symptoms at a mean glucose of 78 mg/dL in one study.
  • Patients on beta-blockers may not have significant autonomic symptoms.

Some patients that are at high risk for hypoglycemia:
  • Children (See Morsel) - high metabolic demands
  • Alcoholics - ETOH inhibits gluconeogenesis and depletes glycogen stores. Plus they don’t eat much.
  • Elderly - cuz they often don’t eat many calories.

Treatment - we often do it wrong!

  • “Give ‘em an amp”
  • Treatment should be 0.5 - 1 g/kg IV of 50% Dextrose (D50W).
  • Use 2 g/kg of D25 in kids and 5 g/kg of D10 in infants.
  • Standard “amp” of D50 has 25 grams.
  • Most adults should get more than one amp.
  • Each “amp” is only 100 cal.
  • Each treatment should be followed by a meal (if patient able to eat).
  • Glucose drip - Need to use D10 (D5 x 1 litre contains only 50 grams (200 cal)).
  • D20 is even better… but requires central line.
  • Glucagon?? -- Useful if you can’t get an IV. Requires adequate glycogen stores to be present to work… may not be effective in kids and alcoholics.
Main Point - Change in Mental Status? Check Glucose early!!

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction