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
Non-insulin secreting fibromas, sarcomas, or fibrosarcomas