Skip to main content

Hypoglycemia, Emergency Medicine

Chadi I. Kahwaji and Matthew N. Graber Reviewed 06/2017
 


Basics

Description

  • Deficiency in counterregulatory hormones (glucagon, epinephrine, cortisol, growth hormone) or excessive insulin response

  • Serum glucose < 70 mg/dL

Risk Factors

  • Strict glycemic control...

Diagnosis

Signs and Symptoms

  • Adrenergic caused by excessive counter-regulatory hormones (i.e., epinephrine):

    • Diaphoresis

    • Anxiety

    • Tachycardia/palpitations

    • Hunger

    • Paresthesias

    • Chest pain

    • Ischemic ECG changes

  • Neu...

Treatment

Pre-Hospital

  • Diagnosis with finger stick glucose

  • IV dextrose preferred

  • Oral glucose–containing fluids in awake patient if unable to obtain IV

  • Glucagon if unable to give IV glucose or oral glucos...

Follow-Up

Disposition

Admission Criteria

  • Overdose of long-acting oral hypoglycemic agent (e.g., sulfonylureas) or long-acting insulin mandate observation for at least 24 hr.

  • Failure of neuroglycopenic sy...

Pearls and Pitfalls

  • Administration of PO glucose or food may initially further decrease glucose level; therefore, IV dextrose always preferred if possible

  • Multiple amps of D50W commonly required

  • Do not ...

Additional Reading

  • McCall  AL. Insulin therapy and hypoglycemia. Endocniol Metab Clin North Am.  2012;41(1):57–87.

  • Service  FJ. Hypoglycemia. Med Clin North Am.  1995;79(1):1–8.

  • Stanley  CA, B...

Codes

ICD9

  • 251.1 Other specified hypoglycemia

  • 251.2 Hypoglycemia, unspecified

  • 775.1 Neonatal diabetes mellitus

ICD10

  • E16.1 Other hypoglycemia

  • E16.2 Hypoglycemia, unspecified

  • P70.2 Neonatal diabetes mellitus

SNOMED

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

×