Hypoglycemia

HISTORY:

Hypoglycemic episodes for ‍ ‍hoursdays

Blood glucose level: ‍

Recent HbA1c level: ‍ %

‍fatigue

‍dizziness

‍sweating

‍hunger

‍irritability

‍anxiety

‍trembling

‍heart palpitations

‍blurred vision

‍confusion

‍seizures

‍loss of consciousness



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumaticnormal scalprashlesion

Eyes: -R: ‍normal, -L: ‍normal, ‍

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash

Extremities: ‍edema, ‍warm, cap refill ‍< 3 sec> 3 sec, pulses ‍normal, ‍

Neurologic: cranial nerves ‍normal, strength ‍5/5 throughout, sensation ‍normal, reflexes ‍2+ throughout, cerebellar function ‍normal, gait ‍stable

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought process ‍organized, ‍no suicidal ideation, judgment ‍good



ASSESSMENT:

Hypoglycemia ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍insulin, ‍C-peptide, ‍cortisol, ‍ACTH

- Immediate ‍oralIV glucose administration

- Normal saline with 5% dextrose at ‍ cc/hr

- ‍Glucagon

- Insulin dose adjustment

- Anti-diabetic medication adjustment

- Advise to avoid fasting

- Referral to endocrinologist

- Follow-up in ‍ ‍daysweeks

- Return if hypoglycemic symptoms persist or if new symptoms develop such as confusion, seizures, or loss of consciousness