Differentiating Hypoglycemia from other diseases: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 4: Line 4:


==Overview==
==Overview==
Hypoglycemia should be differentiated from other causes of autonomic hyperactivity symptoms. Physicians should have history, signs and laboratory reuslts sufficient to help them to identify the cause of hypoglycemia. Neonatal hypoglycemia should be differentiated from other causes of neurological symtpoms in neonates such as: sepsis, metabolic diseases: urea cycle disorders, and branched-chain organic acidemias, hyponatremia and neonatal asphyxia.


==Differentiating Hypoglycemia from other Diseases==
==Differentiating Hypoglycemia from other Diseases==
Line 44: Line 45:
!insulin or insulin receptor antibodies
!insulin or insulin receptor antibodies
|-
|-
|insulinoma
|Insulinoma
| +
| +
| -
| -
Line 53: Line 54:
| -
| -
|-
|-
|oral hypoglycemia agent-induced
|Oral hypoglycemia agent-induced
| -
| -
| -
| -
Line 62: Line 63:
| -
| -
|-
|-
|autoimmune hypoglycemia.
|Autoimmune hypoglycemia.
| -
| -
| -
| -
Line 80: Line 81:
| -
| -
|-
|-
|exogenous insulin
|Exogenous insulin
| -
| -
| -
| -
Line 89: Line 90:
| -
| -
|-
|-
|nonislet cell tumors
|Non-islet cell tumors
| -
| -
| -
| -
Line 103: Line 104:
{| class="wikitable"
{| class="wikitable"
!Disease
!Disease
!
!History and symptoms
!
!Investigations
!
|-
|-
|Sepsis  
|Sepsis  
|
|Irrritability, lethargy, and tachypnea
|
|Blood cultures
|
|-
|-
|Inborn errors of metabolism  
|Inborn errors of metabolism  
|
|
|
* Family history and positive intrapartum screening tests
|
* Symptoms will persist despite measures to increase blood glucose levels
|Positive blood tests
|-
|-
|Hyponatremia  
|Hyponatremia  
|
|lethargy, obtundation, and, eventually, seizures
|
|plasma sodium falls below 125 mEq/L
|
|-
|-
|perinatal asphyxia  
|perinatal asphyxia  
|
|
|
* History of intrapartum complications
|
* Lethargy and irritability
|}
* Symptoms fail to improve with an increase in blood glucose levels.
 
|MRI of acute brain injury confirms the diagnosis of encephalopathy.
In neonates, nonspecific signs of sepsis are often similar to those of hypoglycemia, such as irritability, lethargy, and tachypnea.
|} 
 
 
Because of the serious consequences,
 
empiric antibiotic therapy should be provided (after cultures are obtained) to infants with suspected sepsis pending definitive culture-based diagnosis, in addition to administrating interventions directed towards hypoglycemia.
 
Metabolic diseases that often present between 12 and 72 hours of age after the initiation of oral feeding include hyperglycinemia, urea cycle disorders, and branched-chain organic acidemias. Hypoglycemia may also be an associated finding in patients with some metabolic diseases (table 1) and will persist despite measures to increase blood glucose levels. The diagnosis of inborn errors of metabolism and specific disorders is discussed separately.
 
Patients typically are not symptomatic until serum or plasma sodium falls below 125 mEq/L, and present with neurologic manifestations including lethargy, obtundation, and, eventually, seizures. The diagnosis of hyponatremia is made by obtaining serum electrolyte levels
 
Neonatal encephalopathy can present with lethargy and irritability, but symptoms fail to improve with an increase in blood glucose levels. Evidence by magnetic resonance imaging of acute brain injury confirms the diagnosis of encephalopathy. 
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"

Revision as of 20:20, 19 July 2017

Hypoglycemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypoglycemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Differentiating Hypoglycemia from other diseases On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Differentiating Hypoglycemia from other diseases

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Differentiating Hypoglycemia from other diseases

CDC on Differentiating Hypoglycemia from other diseases

Differentiating Hypoglycemia from other diseases in the news

Blogs on Differentiating Hypoglycemia from other diseases

Directions to Hospitals Treating Hypoglycemia

Risk calculators and risk factors for Differentiating Hypoglycemia from other diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hypoglycemia should be differentiated from other causes of autonomic hyperactivity symptoms. Physicians should have history, signs and laboratory reuslts sufficient to help them to identify the cause of hypoglycemia. Neonatal hypoglycemia should be differentiated from other causes of neurological symtpoms in neonates such as: sepsis, metabolic diseases: urea cycle disorders, and branched-chain organic acidemias, hyponatremia and neonatal asphyxia.

Differentiating Hypoglycemia from other Diseases

Hypoglycemia should be differentiated from other causes of autonomic hyperactivity symptoms which includes:

History and signs Investigations
Anxiety disorders A family history of anxiety disorders

Medical examination is free.

No abnormal investigations
Pheochromocytoma Paroxysms of headache, sweating, palpitations, and hypertension. [1] Plasma fractionated metanephrines, 24-hour urinary fractionated metanephrines, catecholamines.[2]

Computed tomography: Radiological evaluation should follow lab tests to locate site of the tumour.[1]

Arrhythmia Auscultation of the heartbeat or feeling for peripheral pulses shows abnormality. ECG changes according to the cause.
Hyperthyroidism Ocular signs: eyelid retraction and lid-lag. Measuring the level of thyroid-stimulating hormone (TSH) in the blood

Levels of T4 and/or T3 in the blood. Measuring specific antibodies, such as anti-TSH-receptor antibodies in Graves' disease, may contribute to the diagnosis.

Physicians should have history, signs and laboratory reuslts sufficient to help them to identify the cause of hypoglycemia:

Fating symptoms Postprandial symptoms Plasma insulin C-peptide proinsulin Sulfonylurea in plasma insulin or insulin receptor antibodies
Insulinoma + - high high high - -
Oral hypoglycemia agent-induced - - high high high + [16] -
Autoimmune hypoglycemia. - - high high high - + [17]
NIPHS* - + high high high - -
Exogenous insulin - - high low low - -
Non-islet cell tumors - - low low low - -

*(NIPHS) noninsulinoma pancreatogenous hypoglycemia syndrome

Neonatal hypoglycemia should be differentiated from other causes of neurological symtpoms in neonates:

Disease History and symptoms Investigations
Sepsis Irrritability, lethargy, and tachypnea Blood cultures
Inborn errors of metabolism
  • Family history and positive intrapartum screening tests
  • Symptoms will persist despite measures to increase blood glucose levels
 Positive blood tests
Hyponatremia lethargy, obtundation, and, eventually, seizures plasma sodium falls below 125 mEq/L
perinatal asphyxia
  • History of intrapartum complications
  • Lethargy and irritability
  • Symptoms fail to improve with an increase in blood glucose levels.
 MRI of acute brain injury confirms the diagnosis of encephalopathy.

 

Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
Na+, K+, Ca2+ CT /MRI CSF Findings Gold standard test Neck stiffness Motor or Sensory deficit Papilledema Bulging fontanelle Cranial nerves Headache Fever Altered mental status
Brain tumour[1][2] ✔ Cancer cells[3] MRI ✔ ✔ ✔ ✔ ✔ ✔ Cachexia, gradual progression of symptoms
Delirium tremens ✔ Clinical diagnosis ✔ ✔ ✔ ✔ ✔ ✔ Alcohol intake, sudden witdrawl or reduction in consumption Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus,
Subarachnoid hemorrhage[4] ✔ Xanthochromia[5] CT scan without contrast[6][7] ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Trauma/fall Confusion, dizziness, nausea, vomiting
Stroke ✔ Normal CT scan without contrast ✔ ✔ ✔ ✔ ✔ TIAs, hypertension, diabetes mellitus Speech difficulty, gait abnormality
Neurosyphilis[8][9] ✔ ↑ Leukocytes and protein CSF VDRL-specifc

CSF FTA-Ab -sensitive[10]

✔ ✔ ✔ ✔ ✔ ✔ Unprotected sexual intercourse, STIs Blindness, confusion, depression,

Abnormal gait

Viral encephalitis ✔ Increased RBCS or xanthochromia, mononuclear lymphocytosis, high protein content, normal glucose Clinical assesment ✔ ✔ ✔ ✔ ✔ ✔ ✔ Tick bite/mosquito bite/ viral prodome for several days Extreme lethargy, rash hepatosplenomegaly, lymphadenopathy, behavioural changes
Herpes simplex encephalitis ✔ Clinical assesment ✔ ✔ ✔ ✔ ✔ History of hypertension Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy Normal ✔ ✔ ✔ History of alcohal abuse Ophthalmoplegia, confusion
CNS abscess ✔ ↑ leukocytes >100,000/ul, ↓ glucose and ↑ protien, ↑ red blood cells, lactic acid >500mg Contrast enhanced MRI is more sensitive and specific,

Histopathological examination of brain tissue

✔ ✔ ✔ ✔ ✔ ✔ ✔ History of drug abuse, endocarditis, ↓ immune status High grade fever, fatigue,nausea, vomiting
Drug toxicity ✔ ✔ Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder Diagnosis of exclusion ✔ ✔ ✔ ✔ ✔ Tremors, blindness, difficulty swallowing
Electrolyte disturbance ↓ or ↑ Depends on the cause ✔ ✔ Confusion, seizures
Febrile convulsion Not performed in first simple febrile seizures Clinical diagnosis and EEG ✔ ✔ ✔ ✔ Family history of febrile seizures, viral illness or gastroenteritis Age > 1 month,
Subdural empyema ✔ Clinical assesment and MRI ✔ ✔ ✔ ✔ ✔ ✔ History of relapses and remissions Blurry vision, urinary incontinence, fatigue
Hypoglycemia ↓ or ↑ Serum blood glucose

HbA1c

✔ ✔ ✔ History of diabetes Palpitations, sweating, dizziness, low serum, glucose

References

  1. ↑ Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
  2. ↑
  3. ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
  4. ↑ Yeh ST, Lee WJ, Lin HJ, Chen CY, Te AL, Lin HJ (2003) Nonaneurysmal subarachnoid hemorrhage secondary to tuberculous meningitis: report of two cases. J Emerg Med 25 (3):265-70. PMID: 14585453
  5. ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
  6. ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
  7. ↑ DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
  8. ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
  9. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  10. ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Differentiating_Hypoglycemia_from_other_diseases&oldid=1327395"