Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

780 Hypocalcemia Hypoglycemia

■Mg depletion: treatment often self-limited

■Pseudohypoparathyroidism: lifelong treatment, may lose bone mass

over time

Hypoglycemia......................................

FREDRIC B. KRAEMER, MD

history & physical

History

■Diabetes or chronic illness, such as liver or renal failure, currently

hospitalized, medication use, alcohol, psychiatric problems, history

of GI surgery

Signs & Symptoms

■Generally nonspecific, but may include lightheadedness, dizziness,

sweating, palpitations, headache, inability to concentrate, confu-

sion, loss of consciousness, seizures

■Occurrence of symptoms in relation to meals often not helpful

tests

Laboratory

■Basic blood studies:

➣low glucose

■Specific Diagnostic Tests

➣72-h fast with glucose, insulin, C-peptide, proinsulin values; fast

should be halted when patient becomes symptomatic and glu-

cose falls below 55 mg/dL

■Blood for sulfonylureas

■Glucose tolerance tests should not be performed to try to diagnose

postprandial hypoglycemia; likewise, glucose meters for nondia-

betic patients to monitor glucose levels at home should generally

be avoided because of inaccuracy at low glucose values and the high

frequency of falsely low readings due to poor technique

Imaging

■Generally not useful for localization of insulinomas, but CT, MRI,

endoscopic ultrasound, or selective arteriography can be used