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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]], [[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]]
|-
|-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 =====
 
ACTH Deficiency
 
2-Methylbutyryl-Coenzyme  A Dehydrogenase Deficiency
 
3-Alpha-Hydroxyacyl-Coa  Dehydrogenase Deficiency
 
3-Methylcrotonyl-Coa  Carboxylase Deficiency
 
6-Diphosphatase Deficiency
 
Acad9 Deficiency
 
Acetohexamide
 
Acute Fatty Liver Of  Pregnancy
 
Acute Fatty Liver  Of Pregnancy,Hemolytic Disease Of The Newborn
 
Acute Liver  Failure
 
Acute Meningitis
 
Addison's Disease
 
Adrenal Cancer
 
Adrenal Cortex  Insufficiency
 
Adrenal  Hypoplasia Congenital
 
Adrenal  Insufficiency
 
Alcoholism
 
Aldolase A  Deficiency
 
Alpers Syndrome
 
Amprenavir
 
Anorexia Nervosa
 
Aspart
 
Autoimmune Adrenalitis
 
Beckwith-Weidemann  Syndrome Carbohydrate-Deficient Glycoprotein Syndrome Type 1b
 
Benign Glucosuria
 
Binge Drinking
 
Breast Cancer
 
Bullimia Nervosa
 
Burns
 
Cachexia
 
Carnitine  Palmitoyltransferase 1 Deficiency
 
Carnitine-Acylcarnitine  Translocase Deficiency
 
Chloramphenicol
 
Chlorpromazine
 
Chlorpropamide
 
Chronic  Hypoglycemia
 
Cibenzoline
 
Cidofovir
 
Cirrhosis
 
Cleft Lip Palate  Pituitary Deficiency
 
Clove
 
Coenzyme Q  Cytochrome C Reductase Deficiency
 
Congenital  Hyperinsulinism
 
Debrancher  Deficiency
 
Deficiency In  Enzymes Of Fat Oxidation
 
Delayed  Separation Blood Sample
 
Detemir
 
Diabetes Mellitus
 
Diabetes Mellitus  Type 1
 
Diabetes Mellitus  Type 2
 
Diabetic  Gastroparesis
 
Diabetic Mother
 
Diarrhea
 
Dicarboxylic  Aminoaciduria
 
Dihydrolipoamide  Dehydrogenase Deficiency
 
Dipeptidyl
 
Doege-Potter  Syndrome
 
Donohue Syndrome
 
Dopamine Beta  Hydroxylase Deficiency | Dopamine Beta Hydroxylase Deficiency
 
Drip Arm Sample
 
Dumping Syndrome
 
Empagliflozin
 
Ethanol
 
Ethionamide
 
Factitious  Hypoglycemia
 
Factor
 
Familial  Glucocorticoid Deficiency
 
Familial  Hyperinsulinemic Hypoglycemia Type 3
 
Familial  Hyperinsulinemic Hypoglycemia Type 5
 
Familial  Hyperinsulinemic Hypoglycemia Type 7
 
Fasting
 
Fluorodeoxyglucose
 
Fructose  Intolerance
 
Fructose-1
 
Fructose-1-Phosphate  Aldolase Deficiency
 
Fructose-1,6-Bisphosphatase  Deficiency
 
Functioning  Pancreatic Endocrine Tumor
 
Galactose-1-Phosphate  Uridyltransferase Deficiency
 
Galactosemia
 
Galactosemia,Fructose-1-Phosphate  Aldolase Deficiency
 
Gastric Dumping  Syndrome
 
Gastrojejunostomy
 
Gatifloxacin
 
Gestational  Diabetes
 
Ginseng
 
Glargine
 
Glibenclamide
 
Gliclazide
 
Glimepiride
 
Glipizide
 
Gliquidone
 
Glisolamide
 
Glisoxepide
 
Glucagon  Deficiency
 
Glucocorticoid  Deficiency 1
 
Glucokinase  Mutations
 
Glucose 6  Phosphate Dehydrogenase Deficiency
 
Glucose-6-Phosphatase  Deficiency
 
Glutaric Acidemia  Type 2
 
Glyburide
 
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
 
Growth Hormone  Deficiency
 
Heavy Exercise
 
Hemolytic Disease Of The  Newborn
 
Hepatic  Congestion
 
Hepatic Failure
 
Hepatocerebral Form
 
Hepatocyte  Nuclear Factor 1a
 
Hereditary
 
Hereditary Acth  Resistance
 
Hmg Coa  Synthetase Deficiency,Hydroxymethylglutaryl-Coa Lyase Deficiency
 
Hmg-Coa Lyase  Deficiency
 
Hydrochloride
 
Hydroxymethylglutaryl-Coa  Lyase Deficiency
 
Hyperinsulinism
 
Hyperinsulinism-Hyperammonemia  Syndrome
 
Hypoglycemia
 
Hypoketonemic  Hypoglycemia
 
Hypopituitarism
 
Hypothermia
 
Hypothyroidism
 
Idiopathic Growth  Hormone Deficiency
 
Idiopathic  Hypoglycemia
 
Idiopathic  Postprandial Syndrome
 
Igf Producing  Tumors
 
Immunopathologic  Hypoglycemia
 
Inborn Urea Cycle  Disorder
 
Inhibitor
 
Insulin
 
Insulin Like  Growth Factor
 
Insulin Receptor  Antibodies
 
Insulin Shock
 
Insulin-Like
 
Insulinoma
 
Intrauterine  Growth Retardation
 
Isethionate
 
Islet Cell  Adenoma
 
Katp Channel  Defects
 
Ketotic  Hypoglycemia
 
Ketotic  Hypoglycemia Of Infancy
 
Lanreotide
 
Laron Dwarfism
 
Leucine-Induced  Hypoglycaemia
 
Leucinosis
 
Levobunolol
 
Levomepromazine
 
Linagliptin
 
Liver Cancer
 
Liver Glycogen  Synthase Deficiency
 
Long Chain  Hydroxyacyl-Coa Dehydrogenase Deficiency
 
Lorcaserin
 
Malabsorption
 
Malaria
 
Maldigestion
 
Malnutrition
 
Malonic  Aciduria,Malonyl-Coa Decarboxylase Deficiency
 
Malonyl-Coa  Decarboxylase Deficiency
 
Maple Syrup Urine  Disease
 
Mcquarrie Type  Infantile Idiopathic Hypoglycemia
 
Mecasermin
 
Medium Chain  Acyl-Coa Dehydrogenase Deficiency
 
Meropenem
 
Mesothelioma
 
Metastatic  Insulinoma
 
Methylmalonic  Acidemia
 
Mitiglinide
 
Mitochondrial DNA  Depletion Syndrome
 
Mitochondrial  Trifunctional Protein Deficiency
 
Multiple  Endocrine Neoplasia Type 1
 
Munchausen  Syndrome
 
[[Myxedema coma]]
 
[[Nateglinide]]
 
[[Neonatal bacterial meningitis]]
 
[[Nesidioblastosis]]
 
[[Nesidioblastosis]]
 
[[Nitisinone]]
 
[[Organic acidemia]]
 
[[Oxcarbazepine]]
 
[[Pancreatic cancer]]
 
[[Paternal uniparental disomy]]
 
[[Pazopanib]]
 
[[Pegvisomant]]
 
[[Penicillamine]]
 
[[Pentamidine]]
 
[[Peptidase-4]]
 
[[Perazine]]
 
[[Phosphoenolpyruvate carboxykinase deficiency]]
 
[[Pipothiazine]]
 
[[Pituitary Dwarfism]]
 
[[Plasma Membrane  Carnitine Transporter Deficiency]]
 
[[Postgastrectomy  Syndrome]]
 
[[Pramipexole]]
 
[[Pramlintide]]
 
[[Pregnancy]]
 
[[Premature Labour  And/Or Delivery]]
 
[[Primary Carnitine  Deficiency]]
 
[[Propionic  Acidemia]]
 
[[Propionyl-Coa  Carboxylase Deficiency Pcca Type]]
 
[[Pyloroplasty]]
 
[[Pyruvate  Carboxylase Deficiency]]
 
[[Pyruvate  Carboxylase Deficiency|Pyruvate Carboxylase Deficiency]]
 
[[Quinine]]
 
[[Reactive  Hypoglycemia]]
 
[[Renal Failure]]
 
[[Renal Hypoglycemia]]
 
[[Repaglinide]]
 
[[Reye Syndrome]]
 
[[Rifaximin]]
 
[[Ritonavir]]
 
[[Saquinavir]]
 
[[Saxagliptin]]
 
[[Sepsis]]
 
[[Septic Shock]]
 
[[Sertraline]]
 
[[Severe Hepatitis]]
 
[[Sheehan's Syndrome]]
 
[[Shock]]
 
[[Short Chain  Acyl-Coa Dehydrogenase Deficiency]]
 
[[Somatostatin]]
 
[[Starvation]]
 
[[Strenuous Exercise]]
 
[[Sulfamethoxazole]]
 
[[Temafloxacin]]
 
[[Thalidomide]]
 
[[Timme Syndrome]]
 
[[Tolazamide]]
 
[[Tolbutamide]]
 
* [[[Trimethoprim]]]
 
* [[Triple A Syndrome]]
 
* [[Tumors]]
 
* [[Tyrosinaemia Type  1]]
 
[[ Tyrosinemia]]
 
[[Uncoupling Protein 2]]
 
[[Urea Cycle Disorder]]
 
[[Uremia]]
 
[[Very Long-Chain Acyl-Coa Dehydrogenase Deficiency]]
 
[[Vildagliptin]]
 
[[Visceral Leishmaniasis]]
 
[[Wilms Tumor]]
 
 
 
== 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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