Hypoglycemia causes: Difference between revisions

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__NOTOC__
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{{Hypoglycemia}}
{{Hypoglycemia}}
{{CMG}}
{{CMG}} {{AE}} {{CLG}} {{MAD}}


==Overview==
== Overview ==
 
Causes of hypoglycemia depend on age; neonatal causes are transient neonatal hypoglycemia, [[Prematurity]], [[intrauterine growth retardation]], [[perinatal asphyxia]], [[Sepsis|sepsis,]] congenital [[hypopituitarism]], beta sympathomimetic drugs[[Congenital hyperinsulinism|, congenital hyperinsulinism]], [[Infant of diabetic mother (patient information)|infant of a diabetic mother]][[Beckwith-Wiedemann syndrome|, Beckwith-Wiedemann syndrome]] and [[Inborn error of metabolism|inborn errors of carbohydrate metabolism]]. Causes of adult hypoglycemia are: [[insulin]] or insulin secretagogue drugs, [[alcohol]], [[hepatic failure]], [[Renal insufficiency|renal failure]], [[cardiac failure]], [[sepsis]], non-islet cell [[Pancreatic cancer|pancreatic tumors]], [[insulinoma]], reactive hypoglycemia, post [[Gastric bypass surgery|gastric bypass]] hypoglycemia, and [[Autoimmune|autoimmune]]<nowiki/>e hypoglycemia.
==Causes==
== Causes of hypoglycemia ==
===Life Threatening Causes===
=== Hypoglycemia in Newborn Infants ===
 
*Transient neonatal hypoglycemia:
===Common Causes===
**[[Blood glucose]] level in healthy newborns falls due to loss of the mothers' [[glucose]] supply that passes the [[placenta]].<ref name="pmid25819173">{{cite journal| author=Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW et al.| title=Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. | journal=J Pediatr | year= 2015 | volume= 166 | issue= 6 | pages= 1520-5.e1 | pmid=25819173 | doi=10.1016/j.jpeds.2015.02.045 | pmc=4659381 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25819173  }}</ref> [[Plasma glucose]] level is corrected by [[glycogenolysis]] and [[gluconeogenesis]].<ref name="pmid10202173">{{cite journal| author=Stanley CA, Baker L| title=The causes of neonatal hypoglycemia. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 15 | pages= 1200-1 | pmid=10202173 | doi=10.1056/NEJM199904153401510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10202173  }}</ref>
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[1,1-Dichloroethene]], [[ackee fruit food poisoning]], [[clove]], [[ethanol]], ginsen, [[jamaican vomiting sickness]], systemic monochloroacetate poisoning
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetohexamide]], [[amprenavir]], [[chloramphenicol]], [[chlorpromazine]], [[chlorpropamide]], [[cidofovir]], [[cibenzoline]], [[dipeptidyl peptidase-4 inhibitor]], [[empagliflozin]], [[ethanol]], [[ethionamide]], [[fluorodeoxyglucose]], [[gatifloxacin]], [[ginseng]], [[glibenclamide]], [[gliclazide]], [[glimepiride]], [[glipizide]], [[gliquidone]], glisolamide, [[glisoxepide]], [[glyburide]], [[insulin aspart]], [[insulin detemir]], [[insulin glargine]], [[insulin-like growth factor]], [[lanreotide]], [[levomepromazine]], [[levobunolol hydrochloride]], [[linagliptin]], [[lorcaserin]], [[mecasermin]], [[meropenem]], [[mitiglinide]], [[nateglinide]], [[nitisinone]], [[oxcarbazepine]], [[pazopanib]], [[pegvisomant]], [[penicillamine]], [[pentamidine isethionate]], [[perazine]], [[pipothiazine]], [[pramipexole]], [[pramlintide]], [[quinine]], [[repaglinide]], [[rifaximin]], [[ritonavir]], [[saxagliptin]], [[saquinavir]], [[sertraline]], [[somatostatin]], [[sulfamethoxazole]], [[temafloxacin]], [[thalidomide]], [[tolazamide]], [[tolbutamide]], [[trimethoprim]], [[vildagliptin]], [[zonisamide]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Addison's disease]],  [[ACTH deficiency]], [[adrenal cancer]], [[adrenal cortex insufficiency]], [[adrenal insufficiency]], [[autoimmune adrenalitis]], [[congenital hyperinsulinism]], [[diabetes mellitus type 1]], [[diabetes mellitus type 2]], [[diabetic gastroparesis]], [[functioning pancreatic endocrine tumor]], [[glucocorticoid deficiency 1]], [[growth hormone deficiency]], [[hyperinsulinism]], [[hyperinsulinism due to glutamodehydrogenase deficiency]],[[hypopituitarism]], [[hypoglycemia]], [[hypothyroidism]], [[hypopituitarism]], [[islet cell adenoma]], [[insulin]], [[insulinoma]], [[idiopathic growth hormone deficiency]], [[ketotic hypoglycemia]], [[multiple endocrine neoplasia type 1]], [[myxedema coma]], [[nesidioblastosis]], [[pancreatic cancer]], [[pituitary dwarfism II]], [[sheehan's syndrome]], [[timme syndrome]], [[tyrosinemia]], [[Wilms tumor]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute fatty liver of pregnancy]], [[acute liver failure]], [[cirrhosis]], [[diabetic gastroparesis]], [[diarrhea]], [[dumping syndrome]], [[functioning pancreatic endocrine tumor]], [[gastric dumping syndrome]], [[hepatic congestion]], [[hepatic failure]], [[idiopathic postprandial syndrome]], [[Insulinoma]], [[liver cancer]], [[malabsorption]], [[maldigestion]], [[reactive hypoglycemia]], [[severe hepatitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]], [[3-alpha-hydroxyacyl-CoA dehydrogenase deficiency]], [[3-Methylcrotonyl-CoA carboxylase deficiency]], [[ACAD9 deficiency]], [[adrenal hypoplasia congenital, X-linked]], [[acetohexamide]], [[aldolase A deficiency]], [[alpers syndrome]], [[Beckwith-Weidemann Syndrome]] [[carbohydrate-deficient glycoprotein syndrome type 1b]], [[carnitine palmitoyltransferase 1 deficiency]], [[carnitine-acylcarnitine translocase deficiency]], [[Coenzyme Q cytochrome c reductase deficiency]], [[cleft lip palate pituitary deficiency]], [[debrancher deficiency]], [[dicarboxylicaminoaciduria]], [[dihydrolipoamide dehydrogenase deficiency]], [[Donohue syndrome]], [[Dopamine beta hydroxylase deficiency | dopamine beta hydroxylase deficiency]], [[familial glucocorticoid deficiency]], [[familial hyperinsulinemic hypoglycemia type 3]], [[familial hyperinsulinemic hypoglycemia type 5]], [[familial hyperinsulinemic hypoglycemia type 7]], [[fructose-1,6-bisphosphatase deficiency]], [[fructose-1-phosphate aldolase deficiency]], [[galactose-1-phosphate uridyltransferase deficiency]], [[glucose 6 phosphate dehydrogenase deficiency]], [[glutaric acidemia type 2]], [[glucokinase mutations]], [[glycogenosis type 1a]], [[glycogenosis type 1b]], [[glycogenosis type 3]], [[glycogenosis type 6]], [[glycogenosis type 9a]], [[glycogenosis type 9b]], [[glycogenosis type 9c]], [[glycogenosis type V]], [[growth hormone deficiency]], [[hereditary ACTH resistance]], [[hepatocyte nuclear factor 1a]], [[HMG-CoA lyase deficiency]], [[hydroxymethylglutaryl-CoA lyase deficiency]], [[hyperinsulinism-hyperammonemia syndrome]], [[KATP channel defects]], [[Laron dwarfism]], [[leucine-induced hypoglycaemia]], [[liver glycogen synthase deficiency]], [[malonyl-CoA decarboxylase deficiency]], [[maple syrup urine disease]], [[medium chain acyl-CoA dehydrogenase deficiency]], [[methylmalonic acidemia]], [[mitochondrial DNA depletion syndrome, hepatocerebral form]], [[mitochondrial trifunctional protein deficiency]], [[monocarboxylate transporter 1]],[[navajo neurohepatopathy]], [[nesidioblastosis]], [[paternal uniparental disomy]], [[Plasma membrane carnitine transporter deficiency]], [[Propionyl-CoA carboxylase deficiency PCCA type]], [[propionic acidemia]], [[primary carnitine deficiency]], [[pyruvate carboxylase deficiency]], [[Short chain acyl-CoA dehydrogenase deficiency]], [[triple A syndrome]], [[tyrosinaemia type 1]], [[uncoupling protein 2]], [[very long-chain acyl-CoA dehydrogenase deficiency]], [[septic shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Hemolytic disease of the newborn]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Gastrojejunostomy]], [[gastric dumping syndrome]], [[postgastrectomy syndrome]], [[pyloroplasty]], [[Reye syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute meningitis]], [[malaria]], [[neonatal bacterial meningitis]], [[Reye's syndrome]], [[sepsis]], [[visceral leishmaniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Acute meningitis]], [[autonomic dystonia]], [[autonomic neuropathy]], [[elevated vagal tone]], [[Reye's syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Acetohexamide]], [[ACAD9 deficiency]], [[binge drinking]], [[coenzyme Q cytochrome c reductase deficiency]], [[deficiency in enzymes of fat oxidation]], [[diabetes mellitus]], [[diabetic gastroparesis]], [[dicarboxylic aminoaciduria]], [[fructose intolerance]], [[galactosemia]], [[glycogen debranching deficiency]], [[glucose-6-phosphatase deficiency]], [[hypoketonemic hypoglycemia]], [[Ketotic hypoglycemia of infancy]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[organic acidemia]], [[pyruvate carboxylase deficiency|pyruvate carboxylase deficiency]], [[phosphoenolpyruvate carboxykinase (PEPCK) deficiency]], [[Urea cycle disorder]], [[Glucagon deficiency]], [[fructose-1, 6-diphosphatase deficiency]], [[Fructose intolerance]], [[Fructose-1,6-bisphosphatase deficiency, hereditary]], [[galactosemia]],[[fructose-1-phosphate aldolase deficiency]], [[glucose 6 phosphate dehydrogenase deficiency]], [[glutaric acidemia type 2]], [[glycogenosis type 1a]], [[glycogenosis type 1b]], [[glycogenosis type 3]], [[glycogenosis type 6]], [[glycogenosis type 9a]], [[glycogenosis type 9b]], [[glycogenosis type 9c]], [[glycogenosis type V]], [[HMG-CoA lyase deficiency]], [[HMG CoA synthetase deficiency]],[[hydroxymethylglutaryl-CoA lyase deficiency]], [[inborn urea cycle disorder]], [[leucinosis]], [[long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[malabsorption]], [[malonic aciduria]],[[malonyl-CoA decarboxylase deficiency]], [[maple syrup urine disease]], [[medium chain acyl-CoA dehydrogenase deficiency]], [[Methylmalonic acidemia]], [[Nesidioblastosis]], [[organic acidemia]], [[propionic acidemia]], [[propionyl-CoA carboxylase deficiency PCCA type]], [[reactive hypoglycemia]], [[short chain acyl-CoA dehydrogenase deficiency]], [[tyrosinaemia type 1]], [[very long-chain acyl-CoA dehydrogenase deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Diabetic mother]], [[gestational diabetes]], [[intrauterine growth retardation]], [[pregnancy]], [[premature labour and/or delivery]], [[sheehan syndrome]], [[acute fatty liver of pregnancy]],[[hemolytic disease of the newborn]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Adrenal cancer]], [[breast cancer]], [[Doege-potter syndrome]], [[IGF producing tumors]], [[tumors]], [[pancreatic cancer]], [[insulinoma]], [[liver cancer]], [[mesothelioma]], [[metastatic insulinoma  fasting ]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetohexamide]], [[amprenavir]], [[chloramphenicol]], [[chlorpromazine]], [[chlorpropamide]], [[cibenzoline]], [[clove]], [[ethanol]], [[ethionamide]], [[fluorodeoxyglucose]], [[gatifloxacin]], [[ginseng]], [[glibenclamide]], [[gliclazide]], [[glimepiride]], [[glipizide]], [[gliquidone]], [[glisolamide]], [[glisoxepide]], [[insulin]], [[insulin like growth factor ]], [[lanreotide]], [[levomepromazine]], [[mitiglinide]], [[nateglinide]], [[pazopanib]], [[pentamidine]], [[perazine]], [[pipothiazine]], [[pramlintide]], [[quinine]], [[repaglinide]], [[ritonavir]], [[saquinavir]], [[somatostatin]], [[sulfamethoxazole]], [[temafloxacin]], [[tolazamide]], [[tolbutamide]], [[trimethoprim]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anorexia nervosa]], [[Bullimia nervosa]], [[Munchausen syndrome]], [[factitious hypoglycemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Mesothelioma]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Benign glucosuria]], [[renal Failure]], [[renal hypoglycemia]], [[uremia ]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune adrenalitis]], [[hemolytic disease of the newborn]], [[immunopathologic hypoglycemia]], [[insulin receptor antibodies]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Burns]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcoholism]], [[binge drinking]], [[burns]], [[cachexia]], [[chronic hypoglycemia]], [[delayed separation blood sample]], [[drip arm sample]], fasting, [[heavy exercise]], [[hepatic failure]], [[hypothermia]], [[idiopathic hypoglycemia]], [[insulin shock]], [[malnutrition]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[pregnancy]], [[sepsis]], [[starvation]],
[[Strenuous exercise]],  [[Shock]]
|-
|}
 
===Causes in Alphabetical Order===
 
{{MultiCol}}
*[[1,1-Dichloroethene]]
*[[2-methylbutyryl-coenzyme A dehydrogenase deficiency]]
*[[3-alpha-hydroxyacyl-CoA dehydrogenase deficiency]]
*[[3-Methylcrotonyl-CoA carboxylase deficiency]]
*[[ACAD9 deficiency]]
*[[Acetohexamide]]
*[[Ackee fruit ]]
*[[Acute fatty liver of pregnancy]]
*[[Acute liver failure]]
*[[Acute meningitis]]
*[[Addison's disease]]
*[[Adrenal cancer]]
*[[Adrenal cortex insufficiency]]
*[[Adrenal insufficiency]]
*[[Alcoholism]]
*[[Alpers Syndrome]]
*[[Amprenavir]]
*[[Anorexia nervosa]]
*[[Autoimmune adrenalitis]]
*[[Autonomic dystonia]]
*[[Autonomic neuropathy]]
*[[Beginning stages of diabetes]]
*[[Benign glucosuria]]
*[[Binge drinking]]
*[[Bullimia nervosa]]
*[[Burns]]
*[[Cachexia]]
*[[Carbohydrate-deficient glycoprotein syndrome type 1b]]
*[[Carnitine palmitoyltransferase 1 deficiency]]
*[[Carnitine-acylcarnitine translocase deficiency]]
*[[Chloramphenicol]]
*[[Chlorpromazine]]
*[[Chlorpropamide]]
*[[Cidofovir]]
*[[Cibenzoline]]
*[[Cirrhosis]]
*[[Cleft lip palate pituitary deficiency]]
*[[Clove]]
*[[Coenzyme Q cytochrome c reductase deficiency]]
*[[Deficiency in enzymes of fat oxidation]]
*[[Delayed separation blood sample]]
*[[Diabetic gastroparesis]]
*[[Diabetic mother]]
*[[Diarrhea]]
*[[Dicarboxylicaminoaciduria]]
*[[Dihydrolipoamide dehydrogenase deficiency]]
*[[Doege-Potter syndrome]]
*[[Donohue syndrome]]
*[[Dopamine beta-hydroxylase deficiency]]
*[[Drip arm sample]]
*[[Dumping syndrome]]
*[[Elevated vagal tone]]
*[[Ethanol]]
*[[Ethionamide]]
*[[Familial glucocorticoid deficiency]]
*[[Familial hyperinsulinemic hypoglycemia type 3]]
*[[Familial hyperinsulinemic hypoglycemia type 5]]
*[[Familial hyperinsulinemic hypoglycemia type 7]]
*[[Fasting ]]
*[[Fluorodeoxyglucose]]
*[[Fructose intolerance]]
*[[Fructose-1, 6-diphosphatase deficiency]]
*[[Fructose-1-phosphate aldolase deficiency]]
*[[Functioning pancreatic endocrine tumor]]
*[[Galactose-1-phosphate uridyltransferase deficiency]]
*[[Galactosemia]]
*[[Gastric dumping syndrome]]
*[[Gastrojejunostomy]]
*[[Gatifloxacin]]
*[[Gestational diabetes]]
*[[Ginseng]]
*[[Glibenclamide]]
*[[Gliclazide]]
*[[Glimepiride]]
*[[Glipizide]]
*[[Gliquidone]]
*[[Glisolamide]]
*[[Glisoxepide]]
*[[Glucagon deficiency]]
*[[Glucose 6 phosphate dehydrogenase deficiency]]
*[[Glutaric acidemia type 2]]
*[[Glycogen debranching deficiency]]
*[[Glycogenosis type 1a]]
*[[Glycogenosis type 1b]]
*[[Glycogenosis type 3]]
*[[Glycogenosis type 6]]
*[[Glycogenosis type 9a]]
*[[Glycogenosis type 9b]]
*[[Glycogenosis type 9c]]
*[[Glycogenosis type V]]
*[[Growth hormone deficiency (congenital)]]
*[[Heavy exercise]]
*[[Hemolytic disease of the newborn]]
{{ColBreak}}
*[[Hepatic congestion]]
*[[Hepatic failure]]
*[[Hereditary ACTH resistance]]
*[[HMG-CoA lyase deficiency]]
*[[Hydroxymethylglutaryl-CoA lyase deficiency]]
*[[Hyperinsulinism-hyperammonemia syndrome]]
*[[Hypoketonemic hypoglycemia]]
*[[Hypopituitarism]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Idiopathic hypoglycemia]]
*[[Idiopathic postprandial syndrome]]
*[[IGF producing tumors]]
*[[Immunopathologic hypoglycemia]]
*[[Insulin]]
*[[Insulin like growth factor ]]
*[[Insulin lispro]]
*[[Insulin receptor antibodies]]
*[[Insulinoma]]
*[[Intrauterine growth retardation]]
*[[Jamaican vomiting sickness]]
*[[Janumet]] ([[sitagliptin]] and [[metformin]])
*[[Ketotic hypoglycemia of infancy]]
*[[Lanreotide]]
*[[Laron dwarfism]]
*[[Leucine-induced hypoglycaemia]]
*[[Levomepromazine]]
*[[Liver cancer]]
*[[Liver glycogen synthase deficiency]]
*[[Long chain hydroxyacyl-CoA dehydrogenase deficiency]]
*[[Malabsorption]]
*[[Malaria (malignant tertian)]]
*[[Maldigestion]]
*[[Malonyl-CoA decarboxylase deficiency]]
*[[Maple syrup urine disease]]
*[[Mcquarrie type infantile idiopathic hypoglycemia]]
*[[Medium chain acyl-CoA dehydrogenase deficiency]]
*[[Mesothelioma]]
*[[Methylmalonic acidemia]]
*[[Mitiglinide]]
*[[Mitochondrial DNA depletion syndrome, hepatocerebral form]]
*[[Mitochondrial trifunctional protein deficiency]]
*[[Multiple endocrine neoplasia ]]
*[[Munchausen syndrome]]
*[[Myxedema coma]]
*[[Nateglinide]]
*[[Navajo neurohepatopathy]]
*[[Nephroblastomatosis-fetal ascites-macrosomia-wilms tumor]]
*[[Nesidioblastosis]]
*[[Organic acidemia]]
*[[Pazopanib]]
*[[Pentamidine]]
*[[Perazine]]
*[[Phosphoenolpyruvate carboxykinase (PEPCK) deficiency]]
*[[Pipothiazine]]
*[[Plasma membrane carnitine transporter deficiency]]
*[[Postgastrectomy syndrome]]
*[[Pramlintide]]
*[[Pregnancy]]
*[[Premature labour and/or delivery]]
*[[Propionyl-CoA carboxylase deficiency PCCA type]]
*[[Pyloroplasty]]
*[[Quinine]]
*[[Reactive hypoglycemia]]
*[[Renal Failure]]
*[[Renal hypoglycemia]]
*[[Repaglinide]]
*[[Reye syndrome]]
*[[Ritonavir]]
*[[Saquinavir]]
*[[Sepsis]]
*[[Septic shock]]
*[[Severe hepatitis]]
*[[Sheehan syndrome]]
*[[Short chain acyl-CoA dehydrogenase deficiency]]
*[[Short stature-pituitary and cerebellar defects-small sella turcica]]
*[[Somatostatin]]
*[[Starvation (acute)]]
*[[Sulfamethoxazole]]
*[[Systemic monochloroacetate poisoning]]
*[[Temafloxacin]]
*[[Timme syndrome]]
*[[Tolazamide]]
*[[Tolbutamide]]
*[[Trimethoprim]]
*[[Triple A syndrome]]
*[[Tumors]]
*[[Tyrosinaemia type 1]]
*[[Urea cycle disorder]]
*[[Uremia ]]
*[[Very long-chain acyl-CoA dehydrogenase deficiency]]
*[[Visceral leishmaniasis]]
*[[Wiedemann-Beckwith syndrome]]
*[[X-linked congenital adrenal hypoplasia ]]
{{EndMultiCol}}
 
== Causes ==
===Common Causes===
==== Hypoglycemia in Newborn Infants ====
Hypoglycemia is a common problem in critically ill or extremely [[low birthweight infants]]. If not due to maternal hyperglycemia, in most cases it is multifactorial, transient and easily supported. In a minority of cases hypoglycemia turns out to be due to significant [[hyperinsulinism]], [[hypopituitarism]] or an [[inborn error of metabolism]] and presents more of a management challenge.
*Transient neonatal hypoglycemia
**[[Prematurity]], [[intrauterine growth retardation]], [[perinatal asphyxia]]
**Maternal hyperglycemia due to [[diabetes]] or iatrogenic glucose administration
**[[Sepsis]]
**Prolonged fasting (e.g., due to inadequate breast milk or condition interfering with feeding)
*Congenital hypopituitarism
*[[Congenital hyperinsulinism]], several types, both transient and persistent
*[[Inborn error of metabolism|Inborn errors of carbohydrate metabolism]] such as [[glycogen storage disease]]
 
====Hypoglycemia in Young Children====
Single episodes of hypoglycemia due to [[gastroenteritis]] or fasting, but recurrent episodes nearly always indicate either an [[inborn error of metabolism]], congenital hypopituitarism, or congenital hyperinsulinism
*Prolonged fasting
**[[Diarrhea]]l illness in young children, especially [[rotavirus]] [[gastroenteritis]]
*Idiopathic [[ketotic hypoglycemia]]
*Isolated [[growth hormone deficiency]], [[hypopituitarism]]
*[[Hyperinsulinemic hypoglycemia|Insulin excess]]
**Hyperinsulinism due to several [[congenital hyperinsulinism|congenital disorders of insulin secretion]]
**Insulin injected for type 1 diabetes
*[[Gastric dumping syndrome]] (after gastrointestinal surgery)
*Other congenital metabolic diseases; some of the common include
**[[Maple syrup urine disease]] and other [[organic aciduria]]s
**[[Glycogen storage disease|Type 1 glycogen storage disease]]
**Disorders of fatty acid oxidation
**[[Medium chain acylCoA dehydrogenase deficiency]] ([[MCAD]])
*Accidental ingestions
**[[Sulfonylurea]]s, [[propranolol]] and others
**[[Ethanol]] (mouthwash, "leftover morning-after-the-party drinks")
 
====Hypoglycemia in Older Children and Young Adults====
By far the most common cause of severe hypoglycemia in this age range is insulin injected for [[type I diabetes|type 1 diabetes]]. Circumstances should provide clues fairly quickly for the new diseases causing severe hypoglycemia. All of the congenital metabolic defects, congenital forms of [[hyperinsulinism]], and congenital hypopituitarism are likely to have already been diagnosed or are unlikely to start causing new hypoglycemia at this age. [[Body mass]] is large enough to make starvation hypoglycemia and idiopathic [[ketotic hypoglycemia]] quite uncommon. Recurrent mild hypoglycemia may fit a [[reactive hypoglycemia]] pattern, but this is also the peak age for [[idiopathic postprandial syndrome]], and recurrent "spells" in this age group can be traced to [[orthostatic hypotension]] or [[hyperventilation]] as often as demonstrable hypoglycemia.
*Insulin-induced hypoglycemia
**Insulin injected for type 1 diabetes
**Factitious insulin injection ([[Munchausen syndrome]])
**[[Insulin-secreting pancreatic tumor]]
**[[Reactive hypoglycemia]] and [[idiopathic postprandial syndrome]]
*[[Addison's disease]]
*[[Sepsis]]
 
====Hypoglycemia in Older Adults====
The incidence of hypoglycemia due to complex drug interactions, especially involving oral hypoglycemic agents and insulin for diabetes rises with age. Though much rarer, the incidence of insulin-producing tumors also rises with advancing age. Most tumors causing hypoglycemia by mechanisms other than insulin excess occur in adults.
*Insulin-induced hypoglycemia
**Insulin injected for diabetes
**Factitious insulin injection ([[Munchausen syndrome]])
**Excessive effects of oral diabetes drugs, [[beta-blockers]], or drug interactions, [[Tiagabine]]
**[[Insulin-secreting pancreatic tumor]]
**Alimentary (rapid jejunal emptying with exaggerated insulin response)
***After gastrectomy [[dumping syndrome]] or bowel bypass surgery or resection
**[[Reactive hypoglycemia]] and [[idiopathic postprandial syndrome]]
*[[Causes of hypoglycemia#Extrapancreatic Tumors|Tumor hypoglycemia]], Doege-Potter syndrome
*Acquired [[adrenal insufficiency]]
*Acquired [[hypopituitarism]]
*Immunopathologic hypoglycemia <ref name=health.am>{{cite web | Umesh Masharani, MB, BS, MRCP(UK) | title =The Hypoglycemic states - Hypoglycemia |  
publisher=Armenian Medical Network | work =The Hypoglycemic states |  
url=http://www.health.am/db/the-hypoglycemic-states-hypoglycemia/ | year = 2007 }}</ref>


* [[Prematurity]]
* [[Intrauterine growth retardation]]
* [[perinatal asphyxia]]
* Maternal hyperglycemia due to [[diabetes]] or iatrogenic glucose administration
* [[Sepsis]]
* Congenital [[Hypopituitarism|hypopituitarism:]]
** [[Cortisol]] and [[growth hormone]] regulate [[glucose]] level
* Maternal use of [[Beta agonist|beta-sympathomimetics]]
** Interrupts [[glycogenolysis]] by blocking [[Epinephrine|epinephrine']]<nowiki/>s effect.<ref name="pmid27577580">{{cite journal| author=Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A et al.| title=Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages=  | pmid=27577580 | doi=10.1542/peds.2016-0731 | pmc=5005024 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27577580  }}</ref>
* [[Hypothermia|Hypothermic]] infants who have increased rates of glucose utilization and decreased glucose availability.
* Severe [[hepatic]] dysfunction
** Leads to impairment of both [[glycogenolysis]] and [[gluconeogenesis]].
*[[Congenital hyperinsulinism]]:<ref name="pmid23739646">{{cite journal| author=Buraczewska B, Kopacz K, Myśliwiec M| title=Hyperinsulinism as a common cause of hypoglycemia in children - pathogenesis, diagnosis and treatment. | journal=Pediatr Endocrinol Diabetes Metab | year= 2013 | volume= 19 | issue= 1 | pages= 24-8 | pmid=23739646 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23739646  }}</ref>
**[[Infant of diabetic mother (patient information)|Infant of a diabetic mothe]]<nowiki/>r is most commonly affected by hypoglycemia due to [[hyperinsulinism]]. Prolonged intrapartum [[hyperglycemia]] in [[fetus]] leads to [[Hypertrophy (medical)|hypertrophied]] and hyperfunctioning [[beta cells]] causing [[hyperinsulinism]]. It is transient and resolves two days after birth.
**[[Beckwith-Wiedemann syndrome]]
**[[Persistent hyperinsulinemic hypoglycemia of infancy]]: it is a mutation in genes encoding [[enzymes]] that control [[intracellular]] [[metabolic]] pathways of the [[pancreatic]] beta cell.
**Excess [[exogenous]] [[insulin]] given to newborns with [[hyperglycemia]] may result in hypoglycemia.<ref name="pmid19588439">{{cite journal| author=Sinclair JC, Bottino M, Cowett RM| title=Interventions for prevention of neonatal hyperglycemia in very low birth weight infants. | journal=Cochrane Database Syst Rev | year= 2009 | volume=  | issue= 3 | pages= CD007615 | pmid=19588439 | doi=10.1002/14651858.CD007615.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19588439  }}</ref>
**Neonatal conditions associated with excessive [[insulin]] secretion include [[alloimmune]] [[Hemolytic disease of the newborn|hemolytic disease]] of the newborn, [[heart failure]] and [[sepsis]].<ref name="pmid10331464">{{cite journal| author=Sue CM, Hirano M, DiMauro S, De Vivo DC| title=Neonatal presentations of mitochondrial metabolic disorders. | journal=Semin Perinatol | year= 1999 | volume= 23 | issue= 2 | pages= 113-24 | pmid=10331464 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10331464  }}</ref>
**[[Polycythemia]] may lead to greater glucose utilization by the increased mass of red blood cells.
**[[Nesidioblastosis]]
*[[Inborn error of metabolism|Inborn errors of metabolism]]:<ref name="pmid9832597">{{cite journal| author=Burton BK| title=Inborn errors of metabolism in infancy: a guide to diagnosis. | journal=Pediatrics | year= 1998 | volume= 102 | issue= 6 | pages= E69 | pmid=9832597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832597  }}</ref>
**Disorders of [[gluconeogenesis]]: [[Fructose bisphosphatase deficiency|fructose-1,6-bisphosphatase]] deficiency, [[pyruvate carboxylase deficiency]].
**Disorders of [[carbohydrate metabolism]]: [[hereditary fructose intolerance]], [[Galactosemia|galactosemia.]]
**Disorders of [[Fatty acid metabolism|fatty acid metabolism:]] medium or [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency|long-chain acyl-CoA dehydrogenase deficiency]]).<ref name="pmid7726385">{{cite journal| author=Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A et al.| title=Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism. | journal=Brain Dev | year= 1994 | volume= 16 Suppl | issue=  | pages= 81-5 | pmid=7726385 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7726385  }}</ref>
===Hypoglycemia in Adults===
* Drugs are the most common cause of hypoglycemia in adults.<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155  }}</ref> The most important causes of hypoglycemia in adults include:
**[[Insulin]] or insulin secretagogues such as [[sulfonylurea]] and glyburide are the most common drugs that may cause hypoglycemia due to longer duration of action<ref name="pmid16324923">{{cite journal| author=Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE et al.| title=Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia. | journal=Metabolism | year= 2006 | volume= 55 | issue= 1 | pages= 78-83 | pmid=16324923 | doi=10.1016/j.metabol.2005.07.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16324923  }}</ref>. They suppress hepatic [[glucose]] production and stimulate glucose utilization which may result in hypoglycemia.
**[[Quinolones]]
**[[Pentamidine]]
**[[Quinine]]
**[[Beta blockers]]
**[[Angiotensin-converting enzyme inhibitors]]
**[[Insulin-like growth factor-I|IGF-1]]
***Especially in older patients with underlying [[renal]] or [[hepatic]] dysfunction<ref name="pmid25179404">{{cite journal| author=Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS| title=Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas. | journal=JAMA Intern Med | year= 2014 | volume= 174 | issue= 10 | pages= 1605-12 | pmid=25179404 | doi=10.1001/jamainternmed.2014.3293 | pmc=4878670 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25179404  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25686188 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13]</ref>
**[[Alcohol]]
***Due to [[hepatic]] [[glycogen]] depletion in fasting patients
***[[Alcohol]] can induce hypoglycemia alone or associated with other hypoglycemic drugs
* Critical illnesses:
** [[Hepatic failure]]
** [[Renal failure]]
** [[Congestive heart failure|Cardiac failure]]
** [[Sepsis]]
*** It occurs due to impaired liver [[gluconeogenesis]]
*** [[Sepsis]] induced [[cytokines]] secretion cause suppression of [[gluconeogenesis]]<ref name="pmid10807013">{{cite journal| author=Maitra SR, Wojnar MM, Lang CH| title=Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis. | journal=Shock | year= 2000 | volume= 13 | issue= 5 | pages= 379-85 | pmid=10807013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807013  }}</ref>
* [[Hormone]] deficiency: [[cortisol]] in acquired [[adrenal insufficiency|adrenal insufficiency or]] acquired [[hypopituitarism]]<ref name="pmid26563979">{{cite journal| author=Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W| title=Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life. | journal=Eur J Endocrinol | year= 2016 | volume= 174 | issue= 2 | pages= 177-86 | pmid=26563979 | doi=10.1530/EJE-15-0775 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26563979  }}</ref>
* [[Islet cell|Non islet cell]] [[tumor]]: hypoglycemia usually occurs as a result of [[tumor]] production of [[Insulin-like growth factor 2|IGF-2]]
* [[Insulinoma]]
* [[Reactive hypoglycemia]] or postprandial
** A hypoglycemia that occurs as a reaction to food ingestion within 4 hours after meals due to [[Hyperinsulinism|functional hyperinsulinism]]<ref name="pmid24246338">{{cite journal| author=Galati SJ, Rayfield EJ| title=Approach to the patient with postprandial hypoglycemia. | journal=Endocr Pract | year= 2014 | volume= 20 | issue= 4 | pages= 331-40 | pmid=24246338 | doi=10.4158/EP13132.RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24246338  }}</ref>
*[[Gastric bypass|Post gastric bypass]] hypoglycemia
**Rapid [[Jejunum|jejunal]] emptying with exaggerated [[insulin]] response
* [[Insulin]] [[autoimmune]] hypoglycemia
** Occurs in patients who have [[antibodies]] directed to endogenous [[insulin]] or to the [[insulin]] [[receptor]]<ref name="pmid19440117">{{cite journal| author=Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P| title=Autoimmune forms of hypoglycemia. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 3 | pages= 141-53 | pmid=19440117 | doi=10.1097/MD.0b013e3181a5b42e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19440117  }}</ref>
* Accidental, surreptitious, or malicious hypoglycemia
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 19:03, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Carlos A Lopez, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Causes of hypoglycemia depend on age; neonatal causes are transient neonatal hypoglycemia, Prematurity, intrauterine growth retardation, perinatal asphyxia, sepsis, congenital hypopituitarism, beta sympathomimetic drugs, congenital hyperinsulinism, infant of a diabetic mother, Beckwith-Wiedemann syndrome and inborn errors of carbohydrate metabolism. Causes of adult hypoglycemia are: insulin or insulin secretagogue drugs, alcohol, hepatic failure, renal failure, cardiac failure, sepsis, non-islet cell pancreatic tumors, insulinoma, reactive hypoglycemia, post gastric bypass hypoglycemia, and autoimmunee hypoglycemia.

Causes of hypoglycemia

Hypoglycemia in Newborn Infants

Hypoglycemia in Adults

References

  1. ↑ Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW; et al. (2015). "Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management". J Pediatr. 166 (6): 1520–5.e1. doi:10.1016/j.jpeds.2015.02.045. PMC 4659381. PMID 25819173.
  2. ↑ Stanley CA, Baker L (1999). "The causes of neonatal hypoglycemia". N Engl J Med. 340 (15): 1200–1. doi:10.1056/NEJM199904153401510. PMID 10202173.
  3. ↑ Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A; et al. (2016). "Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia". Pediatrics. 138 (3). doi:10.1542/peds.2016-0731. PMC 5005024. PMID 27577580.
  4. ↑ Buraczewska B, Kopacz K, Myśliwiec M (2013). "Hyperinsulinism as a common cause of hypoglycemia in children - pathogenesis, diagnosis and treatment". Pediatr Endocrinol Diabetes Metab. 19 (1): 24–8. PMID 23739646.
  5. ↑ Sinclair JC, Bottino M, Cowett RM (2009). "Interventions for prevention of neonatal hyperglycemia in very low birth weight infants". Cochrane Database Syst Rev (3): CD007615. doi:10.1002/14651858.CD007615.pub2. PMID 19588439.
  6. ↑ Sue CM, Hirano M, DiMauro S, De Vivo DC (1999). "Neonatal presentations of mitochondrial metabolic disorders". Semin Perinatol. 23 (2): 113–24. PMID 10331464.
  7. ↑ Burton BK (1998). "Inborn errors of metabolism in infancy: a guide to diagnosis". Pediatrics. 102 (6): E69. PMID 9832597.
  8. ↑ Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A; et al. (1994). "Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism". Brain Dev. 16 Suppl: 81–5. PMID 7726385.
  9. ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.
  10. ↑ Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE; et al. (2006). "Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia". Metabolism. 55 (1): 78–83. doi:10.1016/j.metabol.2005.07.009. PMID 16324923.
  11. ↑ Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS (2014). "Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas". JAMA Intern Med. 174 (10): 1605–12. doi:10.1001/jamainternmed.2014.3293. PMC 4878670. PMID 25179404. Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13
  12. ↑ Maitra SR, Wojnar MM, Lang CH (2000). "Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis". Shock. 13 (5): 379–85. PMID 10807013.
  13. ↑ Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W (2016). "Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life". Eur J Endocrinol. 174 (2): 177–86. doi:10.1530/EJE-15-0775. PMID 26563979.
  14. ↑ Galati SJ, Rayfield EJ (2014). "Approach to the patient with postprandial hypoglycemia". Endocr Pract. 20 (4): 331–40. doi:10.4158/EP13132.RA. PMID 24246338.
  15. ↑ Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P (2009). "Autoimmune forms of hypoglycemia". Medicine (Baltimore). 88 (3): 141–53. doi:10.1097/MD.0b013e3181a5b42e. PMID 19440117.
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