Internal Medicine

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

Hypoglycemia 781

differential diagnosis

■Healthy appearing patient:

➣Drugs (ethanol, salicylates, quinine, insulin or sulfonylureas in

diabetic patients)

➣Factitious from insulin or sulfonylureas

➣Alimentary

➣Functional

➣Insulinoma

➣Islet hyperplasia/nesidioblastosis

➣Ketotic hypoglycemia

■Ill-appearing patient:

➣Liver failure

➣Renal failure

➣Sepsis

➣Shock

➣Lactic acidosis

➣Iatrogenic

➣Drugs: pentamidine, quinine; drug-dispensing error

➣Parenteral nutrition and insulin therapy

➣Infant of diabetic mother

➣Glycogen storage disease

➣Galactosemia

➣Hereditary fructose intolerance

➣Carnitine deficiency

➣Defects in amino acid and fatty acid metabolism

➣Reye’s syndrome

➣Starvation

➣Anorexia nervosa

➣Hypopituitarism

➣Growth hormone deficiency in infants and children

➣Adrenal insufficiency

➣Large, non-beta cell tumor

➣Autoimmune diseases

management

What to Do First

■Verify that symptoms occur at a time when hypoglycemia is present

and document that the symptoms resolve with correction of the low

glucose level

■If a normal glucose is found at the time of symptoms, no further

evaluation for hypoglycemia generally is needed