Differentiating Hypoglycemia from other diseases: Difference between revisions
Usama Talib (talk | contribs) No edit summary |
No edit summary |
||
Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
Hypoglycemia should be differentiated from other causes of autonomic | Hypoglycemia should be differentiated from other causes of autonomic hyper activity symptoms. Physicians should have history, signs and laboratory results sufficient to help them to identify the cause of hypoglycemia. Neonatal hypoglycemia should be differentiated from other causes of neurological symptoms 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== | ||
==== Hypoglycemia should be differentiated from other causes of autonomic | ==== Hypoglycemia should be differentiated from other causes of autonomic hyper activity symptoms which include: ==== | ||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
Line 15: | Line 15: | ||
|- | |- | ||
|Anxiety disorders | |Anxiety disorders | ||
|A family history of anxiety disorders | | | ||
Medical examination is free. | * A family history of anxiety disorders | ||
* Medical examination is free. | |||
|No abnormal investigations | |No abnormal investigations | ||
|- | |- | ||
Line 34: | Line 35: | ||
|} | |} | ||
==== Physicians should have history, signs and laboratory | ==== Physicians should have history, signs and laboratory results sufficient to help them to identify the cause of hypoglycemia: ==== | ||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
Line 60: | Line 61: | ||
|high | |high | ||
|high | |high | ||
| + | | + | ||
| - | | - | ||
|- | |- | ||
Line 70: | Line 71: | ||
|high | |high | ||
| - | | - | ||
| + | | + | ||
|- | |- | ||
|NIPHS* | |NIPHS* | ||
Line 99: | Line 100: | ||
| - | | - | ||
|} | |} | ||
<nowiki>*</nowiki>(NIPHS) | <nowiki>*</nowiki>(NIPHS) non-insulinoma pancreatogenous hypoglycemia syndrome | ||
==== Neonatal hypoglycemia should be differentiated from other causes of neurological | ==== Neonatal hypoglycemia should be differentiated from other causes of neurological symptoms in neonates: ==== | ||
{| class="wikitable" | {| class="wikitable" | ||
!Disease | !Disease | ||
Line 152: | Line 153: | ||
!<small>Altered mental status</small> | !<small>Altered mental status</small> | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumour]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" /> | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumour|Brain tumor]]<ref name="pmid1278192">Soffer D (1976) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1278192 Brain tumors simulating purulent meningitis.] ''Eur Neurol'' 14 (3):192-7. PMID: [http://pubmed.gov/1278192 1278192]</ref><ref name="pmid3883130" /> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
Line 181: | Line 182: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" |[[Alcohol]] intake, sudden | | style="background: #F5F5F5; padding: 5px;" |[[Alcohol]] intake, sudden withdrawl or reduction in consumption | ||
| style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]], | | style="background: #F5F5F5; padding: 5px;" |[[Tachycardia]], [[diaphoresis]], [[hypertension]], [[tremors]], [[mydriasis]], [[positional nystagmus]], | ||
|- | |- | ||
Line 221: | Line 222: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]] | | style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]] | ||
| style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]- | | style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specific | ||
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
Line 249: | Line 250: | ||
| style="background: #F5F5F5; padding: 5px;" |✔ | | style="background: #F5F5F5; padding: 5px;" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" |✔ | | style="background: #F5F5F5; padding: 5px;" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral | | style="background: #F5F5F5; padding: 5px;" |Tick bite/mosquito bite/ viral prodrome for several days | ||
| style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash [[hepatosplenomegaly]], [[lymphadenopathy]], [[behavioural]] changes | | style="background: #F5F5F5; padding: 5px;" |Extreme lethargy, rash [[hepatosplenomegaly]], [[lymphadenopathy]], [[behavioural|behavioral]] changes | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Herpes simplex encephalitis]] | ||
Line 281: | Line 282: | ||
| style="background: #F5F5F5; padding: 5px;" |✔ | | style="background: #F5F5F5; padding: 5px;" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |History of | | style="background: #F5F5F5; padding: 5px;" |History of alcohol abuse | ||
| style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]] | | style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]] | ||
|- | |- | ||
Line 299: | Line 300: | ||
| style="background: #F5F5F5; padding: 5px;" |✔ | | style="background: #F5F5F5; padding: 5px;" |✔ | ||
| style="background: #F5F5F5; padding: 5px;" |History of [[drug abuse]], [[endocarditis]], '''↓''' [[immune]] status | | style="background: #F5F5F5; padding: 5px;" |History of [[drug abuse]], [[endocarditis]], '''↓''' [[immune]] status | ||
| style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[Nausea and vomiting|nausea]], [[vomiting]] | | style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]], [[Nausea and vomiting|nausea]], [[vomiting]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]] | ||
Line 369: | Line 370: | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" |Clinical | | style="background: #F5F5F5; padding: 5px;" |Clinical assessment and [[MRI]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔ | | style="background: #F5F5F5; padding: 5px; text-align:center" |✔ |
Revision as of 16:53, 20 July 2017
Hypoglycemia Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Differentiating Hypoglycemia from other diseases On the Web |
American Roentgen Ray Society Images of Differentiating Hypoglycemia from other diseases |
Differentiating Hypoglycemia from other diseases in the news |
Risk calculators and risk factors for Differentiating Hypoglycemia from other diseases |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Hypoglycemia should be differentiated from other causes of autonomic hyper activity symptoms. Physicians should have history, signs and laboratory results sufficient to help them to identify the cause of hypoglycemia. Neonatal hypoglycemia should be differentiated from other causes of neurological symptoms 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 hyper activity symptoms which include:
History and signs | Investigations | |
---|---|---|
Anxiety disorders |
|
No abnormal investigations |
Pheochromocytoma | Paroxysms of headache, sweating, palpitations, and hypertension. [1] | Plasma fractionated metanephrines, 24-hour urinary fractionated metanephrines, catecholamines.[1]
2]Computed tomography: Radiological evaluation should follow lab tests to locate site of the tumour..[2] |
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 results 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 | + | - |
Autoimmune hypoglycemia. | - | - | high | high | high | - | + |
NIPHS* | - | + | high | high | high | - | - |
Exogenous insulin | - | - | high | low | low | - | - |
Non-islet cell tumors | - | - | low | low | low | - | - |
*(NIPHS) non-insulinoma pancreatogenous hypoglycemia syndrome
Neonatal hypoglycemia should be differentiated from other causes of neurological symptoms in neonates:
Disease | History and symptoms | Investigations |
---|---|---|
Sepsis | Irrritability, lethargy, and tachypnea | Blood cultures |
Inborn errors of metabolism |
|
Positive blood tests |
Hyponatremia | lethargy, obtundation, and, eventually, seizures | plasma sodium falls below 125 mEq/L |
perinatal asphyxia |
|
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 tumor[3][4] | ✔ | Cancer cells[5] | MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Cachexia, gradual progression of symptoms | ||||
Delirium tremens | ✔ | Clinical diagnosis | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Alcohol intake, sudden withdrawl or reduction in consumption | Tachycardia, diaphoresis, hypertension, tremors, mydriasis, positional nystagmus, | ||||
Subarachnoid hemorrhage[6] | ✔ | Xanthochromia[7] | CT scan without contrast[8][9] | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Trauma/fall | Confusion, dizziness, nausea, vomiting | |
Stroke | ✔ | Normal | CT scan without contrast | ✔ | ✔ | ✔ | ✔ | ✔ | TIAs, hypertension, diabetes mellitus | Speech difficulty, gait abnormality | ||||
Neurosyphilis[10][11] | ✔ | ↑ Leukocytes and protein | CSF VDRL-specific
CSF FTA-Ab -sensitive[12] |
✔ | ✔ | ✔ | ✔ | ✔ | ✔ | 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 prodrome for several days | Extreme lethargy, rash hepatosplenomegaly, lymphadenopathy, behavioral changes | ||
Herpes simplex encephalitis | ✔ | Clinical assesment | ✔ | ✔ | ✔ | ✔ | ✔ | History of hypertension | Delirium, cortical blindness, cerebral edema, seizure | |||||
Wernicke’s encephalopathy | Normal | ✔ | ✔ | ✔ | History of alcohol 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 assessment and MRI | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | History of relapses and remissions | Blurry vision, urinary incontinence, fatigue | ||||
Hypoglycemia | ↓ or ↑ | Serum blood glucose | ✔ | ✔ | ✔ | History of diabetes | Palpitations, sweating, dizziness, low serum, glucose |
References
- ↑ Lenders JW, Pacak K, Walther MM, Linehan WM, Mannelli M, Friberg P; et al. (2002). "Biochemical diagnosis of pheochromocytoma: which test is best?". JAMA. 287 (11): 1427–34. PMID 11903030.
- ↑ Bravo EL (1991). "Pheochromocytoma: new concepts and future trends". Kidney Int. 40 (3): 544–56. PMID 1787652.
- ↑ Soffer D (1976) Brain tumors simulating purulent meningitis. Eur Neurol 14 (3):192-7. PMID: 1278192
- ↑
- ↑ 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.
- ↑ 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
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 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.
- ↑ 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.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ 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.