Hypoglycemia causes: Difference between revisions

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


== 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 of hypoglycemia ==
=== Hypoglycemia in Newborn Infants ===
*Transient neonatal hypoglycemia:
**[[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>


==Overview==
* [[Prematurity]]
 
* [[Intrauterine growth retardation]]
==Causes==
* [[perinatal asphyxia]]
===Life Threatening Causes===
* Maternal hyperglycemia due to [[diabetes]] or iatrogenic glucose administration
 
* [[Sepsis]]
===Common Causes===
* 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.
===Causes by Organ System===
* Severe [[hepatic]] dysfunction
{|style="width:80%; height:100px" border="1"
** Leads to impairment of both [[glycogenolysis]] and [[gluconeogenesis]].
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
*[[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>
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
**[[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]]
|-bgcolor="LightSteelBlue"
**[[Persistent hyperinsulinemic hypoglycemia of infancy]]: it is a mutation in genes encoding [[enzymes]] that control [[intracellular]] [[metabolic]] pathways of the [[pancreatic]] beta cell.
| '''Chemical / poisoning'''
**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>
|bgcolor="Beige"| [[1,1-Dichloroethene]], [[ackee fruit food poisoning]], [[clove]], [[ethanol]], ginsen, [[jamaican vomiting sickness]], systemic monochloroacetate poisoning
**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.
|-bgcolor="LightSteelBlue"
**[[Nesidioblastosis]]  
| '''Dermatologic'''
*[[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>
|bgcolor="Beige"| No underlying causes
**Disorders of [[gluconeogenesis]]: [[Fructose bisphosphatase deficiency|fructose-1,6-bisphosphatase]] deficiency, [[pyruvate carboxylase deficiency]].
|-
**Disorders of [[carbohydrate metabolism]]: [[hereditary fructose intolerance]], [[Galactosemia|galactosemia.]]
|-bgcolor="LightSteelBlue"
**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>
| '''Drug Side Effect'''
===Hypoglycemia in Adults===
|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]]
* 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.
|-bgcolor="LightSteelBlue"
**[[Quinolones]]
| '''Ear Nose Throat'''
**[[Pentamidine]]
|bgcolor="Beige"| No underlying causes
**[[Quinine]]
|-  
**[[Beta blockers]]
|-bgcolor="LightSteelBlue"
**[[Angiotensin-converting enzyme inhibitors]]
| '''Endocrine'''
**[[Insulin-like growth factor-I|IGF-1]]
|bgcolor="Beige"| [[Addison's disease]], [[Adrenal cortex insufficiency]], [[Adrenal insufficiency]], [[Beginning stages of diabetes]], [[Glucagon deficiency]], [[Hypopituitarism]], [[Hypothyroidism]], [[Multiple endocrine neoplasia ]], [[Myxedema coma]], [[Timme syndrome]], [[Familial glucocorticoid deficiency]]
***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
|-bgcolor="LightSteelBlue"
***[[Alcohol]] can induce hypoglycemia alone or associated with other hypoglycemic drugs
| '''Environmental'''
* Critical illnesses:
|bgcolor="Beige"| No underlying causes
** [[Hepatic failure]]
|-
** [[Renal failure]]
|-bgcolor="LightSteelBlue"
** [[Congestive heart failure|Cardiac failure]]  
| '''Gastroenterologic'''
** [[Sepsis]]
|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]]
*** 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>
|-bgcolor="LightSteelBlue"
* [[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>
| '''Genetic'''
* [[Islet cell|Non islet cell]] [[tumor]]: hypoglycemia usually occurs as a result of [[tumor]] production of [[Insulin-like growth factor 2|IGF-2]]
|bgcolor="Beige"| [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]], [[3-alpha-hydroxyacyl-CoA dehydrogenase deficiency]], [[3-Methylcrotonyl-CoA carboxylase deficiency]], [[ACAD9 deficiency]], [[Alpers Syndrome]], [[Carbohydrate-deficient glycoprotein syndrome type 1b]], [[Carnitine palmitoyltransferase 1 deficiency]], [[Carnitine-acylcarnitine translocase deficiency]], [[Cleft lip palate pituitary deficiency]], [[Dicarboxylicaminoaciduria]], [[Dihydrolipoamide dehydrogenase deficiency]], [[Donohue syndrome]], [[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-diphosphatase deficiency]], [[Fructose-1-phosphate aldolase deficiency]], [[Galactose-1-phosphate uridyltransferase 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]], [[Growth hormone deficiency (congenital)]], [[Hereditary ACTH resistance]], [[HMG-CoA lyase deficiency]], [[Hydroxymethylglutaryl-CoA lyase deficiency]], [[Hyperinsulinism-hyperammonemia syndrome]], [[Laron dwarfism]], [[Leucine-induced hypoglycaemia]], [[Liver glycogen synthase deficiency]], [[Long chain hydroxyacyl-CoA dehydrogenase 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]], [[Navajo neurohepatopathy]], [[Nephroblastomatosis-fetal ascites-macrosomia-wilms tumor]], [[Nesidioblastosis]], [[Plasma membrane carnitine transporter deficiency]], [[Propionyl-CoA carboxylase deficiency PCCA type]], [[Short chain acyl-CoA dehydrogenase deficiency]], [[Short stature-pituitary and cerebellar defects-small sella turcica]], [[Triple A syndrome]], [[Tyrosinaemia type 1]], [[Very long-chain acyl-CoA dehydrogenase deficiency]], [[Wiedemann-Beckwith syndrome]], [[X-linked congenital adrenal hypoplasia ]], [[Septic shock]]
* [[Insulinoma]]
|-
* [[Reactive hypoglycemia]] or postprandial
|-bgcolor="LightSteelBlue"
** 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>
| '''Hematologic'''
*[[Gastric bypass|Post gastric bypass]] hypoglycemia
|bgcolor="Beige"| [[Hemolytic disease of the newborn]]
**Rapid [[Jejunum|jejunal]] emptying with exaggerated [[insulin]] response
|-
* [[Insulin]] [[autoimmune]] hypoglycemia
|-bgcolor="LightSteelBlue"
** 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>
| '''Iatrogenic'''
* Accidental, surreptitious, or malicious hypoglycemia
|bgcolor="Beige"| [[Gastrojejunostomy]], [[Postgastrectomy syndrome]], [[Pyloroplasty]], [[Reye syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute meningitis]], [[Malaria (malignant tertian)]], [[Sepsis]], [[Visceral leishmaniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Autonomic dystonia]], [[Autonomic neuropathy]], [[Elevated vagal tone]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Coenzyme Q cytochrome c reductase deficiency]], [[Deficiency in enzymes of fat oxidation]], [[Fructose intolerance]], [[Galactosemia]], [[Glycogen debranching deficiency]], [[Hypoketonemic hypoglycemia]], [[Ketotic hypoglycemia of infancy]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[Organic acidemia]], [[Phosphoenolpyruvate carboxykinase (PEPCK) deficiency]], [[Urea cycle disorder]], [[Glucagon deficiency]], [[ACAD9 deficiency]], [[Dicarboxylicaminoaciduria]], [[Fructose-1, 6-diphosphatase deficiency]], [[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]], [[Hydroxymethylglutaryl-CoA lyase deficiency]], [[Long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[Malonyl-CoA decarboxylase deficiency]], [[Maple syrup urine disease]], [[Medium chain acyl-CoA dehydrogenase deficiency]], [[Methylmalonic acidemia]], [[Nesidioblastosis]], [[Propionyl-CoA carboxylase deficiency PCCA type]], [[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]], [[Doege-Potter syndrome]], [[IGF producing tumors]], [[Tumors]], [[Functioning pancreatic endocrine tumor]], [[Insulinoma]], [[Liver cancer]], [[Mesothelioma]]
|-
|-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]]
|-
|-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]], [[Cachexia]], [[Delayed separation blood sample]], [[Drip arm sample]], [[Fasting ]], [[Heavy exercise]], [[Hypothermia]], [[Idiopathic hypoglycemia]], [[Starvation (acute)]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[Burns]], [[Ethanol]]
|-
|}
 
===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>
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Intensive care medicine]]
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[[Category:Blood tests]]
[[Category:Metabolic disorders]]
[[Category:Disease]]
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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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