0071643192.pdf

Hypoglycemia (Blood Sugar <70 mg/dL)

One of the most common causes of altered mental status in the emergency
department

CAUSES

■ Systemic infection
■ Hypoglycemia of infancy
■ Seen in 4 in 1000 births, usually with one of the following risk factors:
■ Diabetic or narcotic-abusing mothers
■ Premature or small for gestational age infants
■ Postprandial hypoglycemia
■ Occurs within 6 hours of eating and caused by:
■ Alimentary hyperinsulinism or NIDDM
■ Fructose intolerance, leucine sensitivity, or galactemia
■ Fasting hypoglycemia
■ Occurs about 6 hours after eating usually by:
■ Islet cell pancreatic or extrapancreatic tumor
■ Starvation
■ Adrenocortical insufficiency or hypopituitarism
■ Hepatic or renal disease
■ Autoimmune disease
■ Prolonged exercise
■ Late pregnancy
■ Idiopathic/drug-induced
■ Hypoglycemic agents
■ Insulin: Treatment length depends on type of insulin
■ Metformin: Usually potentiated by alcohol abuse
■ Sulfonylureas: Summarized in Table 7.5

SYMPTOMS

Patients usually become symptomatic below 50 mg/dL. They can present with
complaints of:

■ Tremors and agitation
■ Sweating
■ Seizures

EXAM

Patient exams are usually consistent with their symptoms but you may also find:

■ Altered mental status or focal neurologic signs
■ Tachycardia

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

TABLE 7.5. Sulfonylureas

MEDICATION TOLBUTAMIDE GLIPIZIDE GLYBURIDE CHORPROPAMIDE

Associated Warfarin TMP/SMX TMP/SMX, Warfarin

medication Sulfa Miconazole Ciprofloxacin Chloramphenicol

interactions Chloramphenicol ASA H 2 -blockers Probenecid

Rifampin Rifampin Allopurinol

Digoxin Rifampin

Duration 6–12 hrs 12–24 hrs 12–24 hrs 4–5 days