Hypoglycemia

Question 1

Hypoglycemia def

Answer 1

• most common value < 70 mg/dl
• signs not common until glucose < 50 mg/dl

Question 2

Causes of Hypoglycemia

Answer 2

1. Insulinoma
2. Extrapancreatic tumors
3. Addison’s
4. Liver disease
5. Sepsis
6. Insulin O.D.
7. Starvation (young)
8. xylitol intoxication

Question 3

Clinical signs of hypoglycemia

Answer 3

• anxiety
• tachycardia
• bizarre behavior
• weakness and ataxia
• muscle twitching
• dementia
• seizures

Question 4

Insulin OD TX

Answer 4

1. Glucose: 0.5 gm/kg
   
   • no effect if too late
2. Karo syrup orally: 1ml = 1gm = 1/2 ml/kg
3. dextrose 50% = 0.5 gm/ml = 1 ml/kg IV push
   
   • dont OD a 1 pound puppy*****
4. Glucagon: 0.25 to 1.0 mg IM or 0.03 mg/kg IM
   
   • brain insurance

Question 5

Insulinoma

Answer 5

• Bad dz in animals
• look for mets => LIVER
• Midde-aged and older animals
• endocrine tumors are dark (highly vasculurized)
• episodic neuroglycopenia
  
  • hypoglycorachia (low BG in CSF)
• DX by hypoglycemia with inapp inc insulin in blood
  
  • ratio > 50 suggests insulinoma in appropriate clin setting

Question 6

Insulinoma

Medical therapy

Answer 6

1. Frequent feeding
2. Diazoxide
3. Prednisone

Question 7

Pediatric Hypoglycemia

Emergency dose of dextrose

Answer 7

• 50% dextrose 1 mL/kg

Question 8

Hypoglycemia in sepsis

Answer 8

• Gram negative bact and endotoxins
• mechanisms
  
  • inhibits gluconeogenesis
  • Hepatic Glycogen depletion
  • Shift to Anaerobic metabolism

*dysregulated diabetics are susceptible to infection

• routine veinopuncture turns gross necrotic wound

Question 9

Paraneoplastic hypoglycemia

Answer 9

fix by taking out tumor

Question 10

Hypoglycemia of pregnancy

Answer 10

• rare
• normalize BG

Question 11

Addisonian hypoglycemia

Answer 11

• no steroids
• lack gluconeogenesis