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]]. | ||
* 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]]. The symptoms of a single person do tend to be similar from episode to episode. | * 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]]. The symptoms of a single person do tend to be similar from episode to episode. | ||
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* Rate: [[Tachycardia]] may be present. | * Rate: [[Tachycardia]] may be present. | ||
*Rhythm: The pulse is usually regular | *Rhythm: The 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 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> | ||
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=== Signs of neonatal hypoglycemia === | === Signs of neonatal hypoglycemia === | ||
* [[Large for gestational age]] | * [[Large for gestational age]] | ||
* [[Beckwith-Wiedemann syndrome]] signs: [[hemihypertrophy]], [[hepatomegaly]] and [[macroglossia]] | * [[Beckwith-Wiedemann syndrome]] signs: [[hemihypertrophy]], [[hepatomegaly]] and [[macroglossia]] | ||
* [[21-hydroxylase deficiency|Congenital adrenal insufficiency]]: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia | * [[21-hydroxylase deficiency|Congenital adrenal insufficiency]]: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia | ||
Revision as of 19:31, 18 September 2017
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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.
- 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. The symptoms of a single person do tend to be similar from episode to episode.
Vitals
Temperature
- Hypothermia may be present in newborns
Pulse
- Rate: Tachycardia may be present.
- Rhythm: The pulse is usually regular.
- Ventricular arrhythmia is fatal if occurred.[1]
Respiration
- Disturbed breathing may be present
Skin
Eyes
- Staring, "glassy" look
- Dilated pupils
Extremities
- Cyanosis may be present in newborns
Neurologic [2]
- Mental status may be altered
- Myoclonic jerks
- Hypotonia
- Ataxia
- Incoordination
- Focal or general motor deficit
- Paralysis
- Hemiparesis
Signs of neonatal hypoglycemia
- Large for gestational age
- Beckwith-Wiedemann syndrome signs: hemihypertrophy, hepatomegaly and macroglossia
- Congenital adrenal insufficiency: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia
- Congenital hypopituitarism: Midline facial defects and micropenis
- Glycogen storage diseases: hepatomegaly.
References
- ↑ 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.