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| ==== Overview ==== | | ==== Overview ==== |
| | Is when blood sugar decreases to below normal levels. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. Some causes of hypoglycemia are [[chloramphenicol]], [[addison's disease]], [[acute fatty liver of pregnancy]] and [[sepsis]]. |
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| ==== Causes ==== | | ==== Causes ==== |
| ===== Life Threatening Causes ===== | | ===== Life Threatening Causes ===== |
| | * [[Adrenal cancer]] |
| | * [[Acute meningitis]] |
| | * [[Diabetes type 1]] |
| | * [[ketotic hypoglycemia]] |
| | * [[Septic shock]] |
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| ===== Common Causes ===== | | ===== Common Causes ===== |
| | * [[Adrenal cortex insufficiency]] |
| | * [[Burns]] |
| | * [[Ethanol]] |
| | * [[Glibenclamide]] |
| | * [[Reye syndrome]] |
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| ===== Causes by Organ System ===== | | ===== Causes by Organ System ===== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Is when blood sugar decreases to below normal levels. This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. Some causes of hypoglycemia are chloramphenicol, addison's disease, acute fatty liver of pregnancy and sepsis.
Causes
Life Threatening Causes
Common Causes
Causes by Organ System
| Cardiovascular
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No underlying causes
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| Chemical / poisoning
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1,1-Dichloroethene, clove, ethanol, ginsen, jamaican vomiting sickness, systemic monochloroacetate poisoning
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| Dermatologic
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No underlying causes
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| Drug Side Effect
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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
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| Ear Nose Throat
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No underlying causes
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| Endocrine
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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, sheehan's syndrome, timme syndrome, tyrosinemia, Wilms tumor
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| Environmental
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No underlying causes
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| Gastroenterologic
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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
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| Genetic
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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, 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
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| Hematologic
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Hemolytic disease of the newborn
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| Iatrogenic
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Gastrojejunostomy, gastric dumping syndrome, postgastrectomy syndrome, pyloroplasty, Reye syndrome
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| Infectious Disease
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Acute meningitis, malaria, neonatal bacterial meningitis, Reye's syndrome, sepsis, visceral leishmaniasis
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| Musculoskeletal / Ortho
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No underlying causes
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| Neurologic
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Acute meningitis, autonomic dystonia, autonomic neuropathy, elevated vagal tone, Reye's syndrome
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| Nutritional / Metabolic
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Acetohexamide, ACAD9 deficiency, binge drinking, coenzyme Q cytochrome c reductase deficiency, deficiency in enzymes of fat oxidation, 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, 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
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| Obstetric/Gynecologic
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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
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| Oncologic
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Adrenal cancer, breast cancer, Doege-potter syndrome, IGF producing tumors, tumors, pancreatic cancer, insulinoma, liver cancer, mesothelioma, metastatic insulinoma
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| Opthalmologic
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No underlying causes
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| Overdose / Toxicity
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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
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| Psychiatric
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Anorexia nervosa, bulimia nervosa, Munchausen syndrome, factitious hypoglycemia
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| Pulmonary
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Mesothelioma
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| Renal / Electrolyte
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Benign glucosuria, renal failure, renal hypoglycemia, uremia
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| Rheum / Immune / Allergy
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Autoimmune adrenalitis, hemolytic disease of the newborn, immunopathologic hypoglycemia, insulin receptor antibodies
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| Sexual
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No underlying causes
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| Trauma
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Burns
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| Urologic
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No underlying causes
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| Dental
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No underlying causes
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| Miscellaneous
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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
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Causes in Alphabetical Order
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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.
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
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 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.
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.
References
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