Hypoglycemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of hypoglycemic episodes

Blood glucose level: ‍

Recent HbA1c level: ‍ %



Associated symptoms: *Try using right-click for negatives*

‍fatigue

‍dizziness

‍sweating

‍hunger

‍irritability

‍anxiety

‍trembling

‍heart palpitations

‍blurred vision

‍confusion

‍seizures

‍loss of consciousness



Contributing factors:

‍medication dosing error

‍skipping meals

‍alcohol abuse

‍intense exercise without proper food intake

no history of: ‍diabetes, ‍pancreatic disorders, ‍liver disease, ‍kidney disorders

no use of: ‍GLP-1, ‍DPP-4, ‍SGLT-2, ‍sulfonylureas, ‍thiazolidinediones, ‍insulin





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

Hypoglycemia ‍likelysuspectedpossible

DDx: excessive dose of insuline, excessive dose of hypoglycemic agents, medication error, inadequate insulin adjustment with food intake, postprandial hypoglycemia, reactive hypoglycemia, fasting hypoglycemia, exercise-induced hypoglycemia, alcohol-induced hypoglycemia, critical illness, sepsis, insulinoma, adrenal insufficiency, severe illness, inborn errors of metabolism, factitious hypoglycemia





PLAN:

Investigations:

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

Treatments:

- Immediate ‍oralIV glucose administration

- Normal saline with 5% dextrose at ‍ cc/hr

- ‍Glucagon

- Insulin dose adjustment

- Anti-diabetic medication adjustment

- Advise to avoid fasting

Further care:

- 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