Hypoglycemia physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Main signs of hypoglycemia are [[ | Main signs of hypoglycemia are [[tachycardia]] and [[Ventricular arrhythmias|ventricular arrhythmia]]. Neurological manifestations include altered [[Mental status examination|mental status]], [[hypotonia]], focal or general motor deficit and [[Jerk|jerks]]. Neonatal hypoglycemia signs include [[large for gestational age]],[[Hepatomegaly| hepatomegaly]] in [[Beckwith-Wiedemann syndrome]] and [[Glycogen storage disease|glycogen storage diseases]]. [[Ambiguous genitalia|Ambiguous genitalia,]] [[hypertension]], [[hyponatremia]], and [[hyperkalemia]] are found in [[21-hydroxylase deficiency|congenital adrenal insufficiency]]. | ||
== Physical examination == | == Physical examination == | ||
===Appearance=== | ===Appearance=== | ||
* [[Macrosomia]] in [[infancy]] | * [[Macrosomia]] in [[infancy]] may indicate [[congenital hyperinsulinism|hyperinsulinism]].<ref name="pmid24685363">{{cite journal| author=Brutsaert E, Carey M, Zonszein J| title=The clinical impact of inpatient hypoglycemia. | journal=J Diabetes Complications | year= 2014 | volume= 28 | issue= 4 | pages= 565-72 | pmid=24685363 | doi=10.1016/j.jdiacomp.2014.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24685363 }}</ref> | ||
* In older children and adults, moderately severe hypoglycemia can resemble [[mania]], mental illness, drug intoxication, or [[drunkenness]]. In the elderly, hypoglycemia can produce focal [[stroke]] | * In older children and adults, moderately severe hypoglycemia can resemble [[mania]], [[mental illness]], [[drug intoxication]], or [[drunkenness]]. In the elderly, hypoglycemia can produce focal [[stroke|stroke-like]] effects or a hard-to-define [[malaise]]. | ||
=== Vitals === | === Vitals === | ||
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==== Pulse ==== | ==== Pulse ==== | ||
* | * Heart rate: [[Tachycardia]] may be present. | ||
*Rhythm: | *Rhythm: Pulse is usually regular. | ||
*Ventricular arrhythmia is fatal if occurred.<ref name="pmid17404614">{{cite journal| author=Cryer PE| title=Hypoglycemia, functional brain failure, and brain death. | journal=J Clin Invest | year= 2007 | volume= 117 | issue= 4 | pages= 868-70 | pmid=17404614 | doi=10.1172/JCI31669 | pmc=1838950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17404614 }}</ref> | *[[Ventricular arrhythmias|Ventricular arrhythmia]] is fatal if occurred.<ref name="pmid17404614">{{cite journal| author=Cryer PE| title=Hypoglycemia, functional brain failure, and brain death. | journal=J Clin Invest | year= 2007 | volume= 117 | issue= 4 | pages= 868-70 | pmid=17404614 | doi=10.1172/JCI31669 | pmc=1838950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17404614 }}</ref> | ||
==== Respiration ==== | ==== Respiration ==== | ||
* | * [[Tachypnea]] | ||
===Skin=== | ===Skin=== | ||
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===Eyes=== | ===Eyes=== | ||
*[[Dilated pupils]] | *[[Dilated pupils]] | ||
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*[[Cyanosis]] may be present in newborns | *[[Cyanosis]] may be present in newborns | ||
=== Neurologic <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> | === Neurologic === | ||
* [[Mental status]] may be altered<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> | |||
*[[ | *[[Myoclonus]] | ||
*[[Hypotonia]] | *[[Hypotonia]] | ||
* [[Ataxia]] | * [[Ataxia]] | ||
| Line 46: | Line 45: | ||
* [[Hemiparesis]] | * [[Hemiparesis]] | ||
=== | === Neonatal Physical examination === | ||
* Large for gestational age | * [[Large for gestational age]]<ref name="pmid24685363" /> | ||
* [[Beckwith-Wiedemann syndrome]] signs: [[hemihypertrophy]], [[hepatomegaly]], and [[macroglossia]]<ref name="pmid24275620">{{cite journal| author=Rozance PJ| title=Update on neonatal hypoglycemia. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2014 | volume= 21 | issue= 1 | pages= 45-50 | pmid=24275620 | doi=10.1097/MED.0000000000000027 | pmc=4012366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275620 }}</ref> | |||
* Beckwith-Wiedemann syndrome signs: hemihypertrophy, hepatomegaly and macroglossia. | * [[21-hydroxylase deficiency|Congenital adrenal insufficiency]]: [[ambiguous genitalia]], [[hypertension]], [[hyponatremia]], and [[hyperkalemia]]<ref name="pmid24854693">{{cite journal| author=Lang T| title=Neonatal hypoglycemia. | journal=Clin Biochem | year= 2014 | volume= 47 | issue= 9 | pages= 718-9 | pmid=24854693 | doi=10.1016/j.clinbiochem.2014.05.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24854693 }}</ref> | ||
* Congenital adrenal insufficiency: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia. | * [[Hypopituitarism|Congenital hypopituitarism]]: [[Facial defect|Midline facial defects]] and [[micropenis]] | ||
* Congenital hypopituitarism: Midline facial defects and micropenis | * [[Glycogen storage disease|Glycogen storage diseases]]: [[Hepatomegaly|Hepatomegaly.]] | ||
* Glycogen storage diseases: Hepatomegaly. | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 20:38, 15 November 2017
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Hypoglycemia physical examination On the Web |
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Risk calculators and risk factors for Hypoglycemia physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Main signs of hypoglycemia are tachycardia and ventricular arrhythmia. Neurological manifestations include altered mental status, hypotonia, focal or general motor deficit and jerks. Neonatal hypoglycemia signs include large for gestational age, hepatomegaly in Beckwith-Wiedemann syndrome and glycogen storage diseases. Ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia are found in congenital adrenal insufficiency.
Physical examination
Appearance
- Macrosomia in infancy may indicate hyperinsulinism.[1]
- In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness. In the elderly, hypoglycemia can produce focal stroke-like effects or a hard-to-define malaise.
Vitals
Temperature
- Hypothermia may be present in newborns
Pulse
- Heart rate: Tachycardia may be present.
- Rhythm: Pulse is usually regular.
- Ventricular arrhythmia is fatal if occurred.[2]
Respiration
Skin
Eyes
Extremities
- Cyanosis may be present in newborns
Neurologic
- Mental status may be altered[3]
- Myoclonus
- Hypotonia
- Ataxia
- Incoordination
- Focal or general motor deficit
- Paralysis
- Hemiparesis
Neonatal Physical examination
- Large for gestational age[1]
- Beckwith-Wiedemann syndrome signs: hemihypertrophy, hepatomegaly, and macroglossia[4]
- Congenital adrenal insufficiency: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia[5]
- Congenital hypopituitarism: Midline facial defects and micropenis
- Glycogen storage diseases: Hepatomegaly.
References
- ↑ 1.0 1.1 Brutsaert E, Carey M, Zonszein J (2014). "The clinical impact of inpatient hypoglycemia". J Diabetes Complications. 28 (4): 565–72. doi:10.1016/j.jdiacomp.2014.03.002. PMID 24685363.
- ↑ Cryer PE (2007). "Hypoglycemia, functional brain failure, and brain death". J Clin Invest. 117 (4): 868–70. doi:10.1172/JCI31669. PMC 1838950. PMID 17404614.
- ↑ 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.
- ↑ Rozance PJ (2014). "Update on neonatal hypoglycemia". Curr Opin Endocrinol Diabetes Obes. 21 (1): 45–50. doi:10.1097/MED.0000000000000027. PMC 4012366. PMID 24275620.
- ↑ Lang T (2014). "Neonatal hypoglycemia". Clin Biochem. 47 (9): 718–9. doi:10.1016/j.clinbiochem.2014.05.026. PMID 24854693.