HYPOGLYCEMIA
HYPOGLYCEMIA: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is the patient taking oral hypoglycemia drugs or insulin? If so, the dosage may be too high.
- Is there a history of weight gain and/or episode of loss of consciousness? This would strongly suggest an insulinoma is the cause.
- What is the plasma cortisol? If this is decreased, look for Addison's disease!
- What is the plasma growth hormone? If this is decreased, look for Simmonds' disease.
- What does a
d-
xylose absorption test show? If this is abnormal, look for malabsorption syndrome. If the diagnosis is still in doubt, the patient may have cirrhosis, glycogen storage disease, hypothyroidism, or functional hypoglycemia.
DIAGNOSTIC WORKUP
The finding of hypoglycemia on routine blood analysis requires nothing in an asymptomatic patient. If there is doubt, a repeat analysis should be done. If the patient is symptomatic, a 5-hr glucose tolerance test or hospitalization for repeated blood sugar during a 72-hr fast should be done. If these are negative, the patient most likely has functional hypoglycemia. Additional tests to order include a T
4
, plasma, cortisol, plasma growth hormone assay, plasma proinsulin, C-peptide, plasma insulin, CT scan of the abdomen, and a tolbutamide tolerance test. Obtain an endocrinology consult.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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