Hypoglycemia

    • Treat symptomatic patient with hypoglycemia, promptly as hypoglycemic encephalopathy may progress rapidly and may become irreversible.

    • Prolonged hypoglycemia at levels less than 30 mg/dL or lower invariably leads to irreversible brain damage.

    • Clinical findings:

      • Tachycardia, sweating, tremulousness, pupillary dilatation, restlessness, confusional state with somnolence or agitation.

      • Neurological manifestation progresses in a rostro-caudal fashion, and may mimic a mass lesion causing transtentorial herniation.

      • Coma with spasticity, extensor plantar responses, decorticate or decerebrate posturing.

      • Signs of brainstem dysfunction appear, subsequently, including abnormal ocular movements and loss of pupillary reflexes.

      • Respiratory depression, bradycardia, hypotonia, and hyporeflexia ultimately supervene, at which point brain damage is irreversible.

    • Mild hypoglycemia can be treated with oral sweetened juices.

    • Severe hypoglycemia with symptoms should receive D50W IV (1 Amp of 50% dextrose) even before the blood glucose is known.

    • If IV access is unavailable with severe hypoglycemia, give glucagon, 1 mg SC or IM.

    • Review patient's medications for oral hypoglycemics.

    • If ongoing hypoglycemia occurs or the patient is NPO, start a maintenance D5W infusion at 75 - 100 mL/hr.

Causes:

    • Insulin OD in diabetic patients

    • Oral hypoglycemic

    • Alcoholism

    • Malnutrition

    • Hepatic failure