Internal Medicine

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

782 Hypoglycemia

General Measures

■Use history to establish the clinical setting in which symptoms occur,

then use diagnostic tests to establish cause

■Occurrence of hypoglycemia in a patient with a known underlying

disease known to be associated with hypoglycemia generally requires

no further evaluation

■Drugs, including insulin, most common cause in hospitalized

patients

specific therapy

■Symptomatic patient: give oral or IV glucose

■Hypoglycemia secondary to drugs or alcohol: remove inciting agent

or adjust dose of insulin or sulfonylurea in diabetic; patients with

hypoglycemia due to sulfonylureas may require hospitalization and

prolonged IV glucose (D 10 W)

■Factitious hypoglycemia: refer for psychiatric evaluation/care

■Alimentary hypoglycemia: try frequent small meals, avoiding large

carbohydrate loads; if persists, oral Dilantin, oral diazoxide, or SC

octreotide

■Functional hypoglycemia: try frequent small meals, avoiding large

carbohydrate loads; psychiatric counseling/treatment for depres-

sion

■Insulinoma: surgical resection; 10% malignant; for nonsurgical

cures, oral diazoxide or SC octreotide for control of hypoglycemia,

chemotherapy for treatment of tumor

■Ill/hospitalized patients: treatment of underlying condition and sup-

portive care with oral and/or parenteral nutrition

■Hormone deficiencies: replacement of glucocorticoids and/or

growth hormone

■Large, non-beta cell tumor: surgical resection and chemotherapy, SC

octreotide or growth hormone for control of hypoglycemia

■Autoimmune diseases: glucocorticoids and immunosuppressive

agents

Side Effects & Contraindications

■Diazoxide:

➣Side effects: edema, lanugo hair growth

➣Contraindications: none

■Octreotide:

➣Side effects: nausea, vomiting, diarrhea

➣Contraindications: none