Hypoglycemia causes: Difference between revisions
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**Disorders of [[Fatty acid metabolism|fatty acid metabolism:]] medium or [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency|long-chain acyl-CoA dehydrogenase deficiency]]).<ref name="pmid7726385">{{cite journal| author=Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A et al.| title=Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism. | journal=Brain Dev | year= 1994 | volume= 16 Suppl | issue= | pages= 81-5 | pmid=7726385 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7726385 }}</ref> | **Disorders of [[Fatty acid metabolism|fatty acid metabolism:]] medium or [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency|long-chain acyl-CoA dehydrogenase deficiency]]).<ref name="pmid7726385">{{cite journal| author=Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A et al.| title=Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism. | journal=Brain Dev | year= 1994 | volume= 16 Suppl | issue= | pages= 81-5 | pmid=7726385 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7726385 }}</ref> | ||
===Hypoglycemia in Older Adults=== | ===Hypoglycemia in Older Adults=== | ||
* Drugs | * Drugs are the most common cause of hypoglycemia in elderly.<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> The most important causes of hypoglycemia in elderly include: | ||
**[[Insulin]] or insulin | **[[Insulin]] or insulin secretagogues such as [[sulfonylurea]] and glyburide are the most common drugs induce hypoglycemia due to longer duration of action<ref name="pmid16324923">{{cite journal| author=Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE et al.| title=Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia. | journal=Metabolism | year= 2006 | volume= 55 | issue= 1 | pages= 78-83 | pmid=16324923 | doi=10.1016/j.metabol.2005.07.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16324923 }}</ref>. They suppress hepatic [[glucose]] production and stimulate glucose utilization causing hypoglycemia. | ||
**Quinolones | **Quinolones | ||
**Pentamidine | **Pentamidine | ||
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**Angiotensin-converting enzyme inhibitors | **Angiotensin-converting enzyme inhibitors | ||
**[[Insulin-like growth factor-I|IGF-1]] | **[[Insulin-like growth factor-I|IGF-1]] | ||
***Especially in older patients with underlying renal or hepatic dysfunctions | ***Especially in older patients with underlying renal or hepatic dysfunctions<ref name="pmid25179404">{{cite journal| author=Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS| title=Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas. | journal=JAMA Intern Med | year= 2014 | volume= 174 | issue= 10 | pages= 1605-12 | pmid=25179404 | doi=10.1001/jamainternmed.2014.3293 | pmc=4878670 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25179404 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25686188 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13]</ref> | ||
**[[Alcohol]] | **[[Alcohol]] | ||
***Due to hepatic glycogen depletion in fasting patients | ***Due to hepatic glycogen depletion in fasting patients | ||
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** [[Sepsis]] | ** [[Sepsis]] | ||
*** It occurs due to impaired liver [[gluconeogenesis]] | *** It occurs due to impaired liver [[gluconeogenesis]] | ||
*** [[Sepsis]] induced [[cytokines]] secretion cause suppression of [[gluconeogenesis]] | *** [[Sepsis]] induced [[cytokines]] secretion cause suppression of [[gluconeogenesis]]<ref name="pmid10807013">{{cite journal| author=Maitra SR, Wojnar MM, Lang CH| title=Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis. | journal=Shock | year= 2000 | volume= 13 | issue= 5 | pages= 379-85 | pmid=10807013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807013 }}</ref> | ||
* Hormone deficiency: | * Hormone deficiency: Cortisol in acquired [[adrenal insufficiency|adrenal insufficiency or]] acquired [[hypopituitarism]]<ref name="pmid26563979">{{cite journal| author=Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W| title=Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life. | journal=Eur J Endocrinol | year= 2016 | volume= 174 | issue= 2 | pages= 177-86 | pmid=26563979 | doi=10.1530/EJE-15-0775 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26563979 }}</ref> | ||
* Nonislet cell tumor: Hypoglycemia usually occurs as a result of tumor production of [[Insulin-like growth factor 2|IGF-2]] | * Nonislet cell tumor: Hypoglycemia usually occurs as a result of tumor production of [[Insulin-like growth factor 2|IGF-2]] | ||
* [[Insulinoma]] | * [[Insulinoma]] | ||
* Reactive hypoglycemia or postprandial | * Reactive hypoglycemia or postprandial | ||
*[[Gastric bypass|Post gastric bypass]] hypoglycemia | ** A hypoglycemia that occurs as a reaction to food ingestion within 4 hours after meals due to [[Hyperinsulinism|functional hyperinsulinism]]<ref name="pmid24246338">{{cite journal| author=Galati SJ, Rayfield EJ| title=Approach to the patient with postprandial hypoglycemia. | journal=Endocr Pract | year= 2014 | volume= 20 | issue= 4 | pages= 331-40 | pmid=24246338 | doi=10.4158/EP13132.RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24246338 }}</ref> | ||
* [[Insulin]] autoimmune hypoglycemia | *[[Gastric bypass|Post gastric bypass]] hypoglycemia | ||
**Rapid [[Jejunum|jejunal]] emptying with exaggerated [[insulin]] response | |||
* [[Insulin]] autoimmune hypoglycemia | |||
** Occurs in patients who have [[antibodies]] directed to endogenous [[insulin]] or to the [[insulin]] receptor<ref name="pmid19440117">{{cite journal| author=Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P| title=Autoimmune forms of hypoglycemia. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 3 | pages= 141-53 | pmid=19440117 | doi=10.1097/MD.0b013e3181a5b42e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19440117 }}</ref> | |||
* Accidental, surreptitious, or malicious hypoglycemia | * Accidental, surreptitious, or malicious hypoglycemia | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 18:16, 18 September 2017
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Hypoglycemia causes On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Carlos A Lopez, M.D. [2] Mohammed Abdelwahed M.D[3]
Overview
Causes of hypoglycemia depend on age; neonatal causes are transient neonatal hypoglycemia, Prematurity, intrauterine growth retardation, perinatal asphyxia, sepsis, congenital hypopituitarism, beta sympathomimetic drugs, congenital hyperinsulinism, infant of a diabetic mother, Beckwith-Wiedemann syndrome and inborn errors of carbohydrate metabolism. Cause of adult hypoglycemia are: insulin or insulin secretagogue drugs, alcohol, hepatic, renal, or cardiac failure, sepsis, non-islet cell pancreatic tumors, insulinoma, reactive hypoglycemia, post gastric bypass hypoglycemia, autoimmune hypoglycemia.
Causes of hypoglycemia
Hypoglycemia in Newborn Infants
- Transient neonatal hypoglycemia:
- Prematurity
- intrauterine growth retardation
- perinatal asphyxia
- Maternal hyperglycemia due to diabetes or iatrogenic glucose administration
- Sepsis
- Congenital hypopituitarism:
- Cortisol and growth hormone regulate glucose level
- Maternal treatment with beta-sympathomimetics
- Interrupts glycogenolysis by blocking epinephrine's effect.[3]
- Hypothermic infants who have diminished the availability of glucose and increased rates of glucose utilization.
- Severe hepatic dysfunction
- Leads to impairment of both glycogenolysis and gluconeogenesis.
- Congenital hyperinsulinism:[4]
- Infant of a diabetic mother is the most common cause of hypoglycemia due to hyperinsulinism. Prolonged intrapartum hyperglycemia in fetus leads to hypertrophied and hyperfunctioning beta cells causing hyperinsulinism. It is transient and resolves two days after birth.
- Beckwith-Wiedemann syndrome
- Persistent hyperinsulinemic hypoglycemia of infancy: it is a mutation in genes encoding enzymes that control intracellular metabolic pathways of the pancreatic beta cell.
- Excess exogenous insulin given to newborns with hyperglycemia may result in hypoglycemia.[5]
- Neonatal conditions associated with excessive insulin secretion include alloimmune hemolytic disease of the newborn, heart failure and sepsis.[6]
- Polycythemia may lead to greater glucose utilization by the increased mass of red blood cells.
- Inborn errors of metabolism:[7]
- Disorders of gluconeogenesis: fructose-1,6-bisphosphatase deficiency, pyruvate carboxylase deficiency.
- Disorders of carbohydrate metabolism: hereditary fructose intolerance, galactosemia.
- Disorders of fatty acid metabolism: medium or long-chain acyl-CoA dehydrogenase deficiency).[8]
Hypoglycemia in Older Adults
- Drugs are the most common cause of hypoglycemia in elderly.[9] The most important causes of hypoglycemia in elderly include:
- Insulin or insulin secretagogues such as sulfonylurea and glyburide are the most common drugs induce hypoglycemia due to longer duration of action[10]. They suppress hepatic glucose production and stimulate glucose utilization causing hypoglycemia.
- Quinolones
- Pentamidine
- Quinine
- Beta blockers
- Angiotensin-converting enzyme inhibitors
- IGF-1
- Especially in older patients with underlying renal or hepatic dysfunctions[11]
- Alcohol
- Due to hepatic glycogen depletion in fasting patients
- Alcohol can induce hypoglycemia alone or associated with other hypoglycemic drugs
- Critical illnesses:
- Hepatic failure
- Renal failure
- Cardiac failure
- Sepsis
- It occurs due to impaired liver gluconeogenesis
- Sepsis induced cytokines secretion cause suppression of gluconeogenesis[12]
- Hormone deficiency: Cortisol in acquired adrenal insufficiency or acquired hypopituitarism[13]
- Nonislet cell tumor: Hypoglycemia usually occurs as a result of tumor production of IGF-2
- Insulinoma
- Reactive hypoglycemia or postprandial
- A hypoglycemia that occurs as a reaction to food ingestion within 4 hours after meals due to functional hyperinsulinism[14]
- Post gastric bypass hypoglycemia
- Insulin autoimmune hypoglycemia
- Occurs in patients who have antibodies directed to endogenous insulin or to the insulin receptor[15]
- Accidental, surreptitious, or malicious hypoglycemia
References
- ↑ Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW; et al. (2015). "Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management". J Pediatr. 166 (6): 1520–5.e1. doi:10.1016/j.jpeds.2015.02.045. PMC 4659381. PMID 25819173.
- ↑ Stanley CA, Baker L (1999). "The causes of neonatal hypoglycemia". N Engl J Med. 340 (15): 1200–1. doi:10.1056/NEJM199904153401510. PMID 10202173.
- ↑ Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A; et al. (2016). "Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia". Pediatrics. 138 (3). doi:10.1542/peds.2016-0731. PMC 5005024. PMID 27577580.
- ↑ Buraczewska B, Kopacz K, Myśliwiec M (2013). "Hyperinsulinism as a common cause of hypoglycemia in children - pathogenesis, diagnosis and treatment". Pediatr Endocrinol Diabetes Metab. 19 (1): 24–8. PMID 23739646.
- ↑ Sinclair JC, Bottino M, Cowett RM (2009). "Interventions for prevention of neonatal hyperglycemia in very low birth weight infants". Cochrane Database Syst Rev (3): CD007615. doi:10.1002/14651858.CD007615.pub2. PMID 19588439.
- ↑ Sue CM, Hirano M, DiMauro S, De Vivo DC (1999). "Neonatal presentations of mitochondrial metabolic disorders". Semin Perinatol. 23 (2): 113–24. PMID 10331464.
- ↑ Burton BK (1998). "Inborn errors of metabolism in infancy: a guide to diagnosis". Pediatrics. 102 (6): E69. PMID 9832597.
- ↑ Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A; et al. (1994). "Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism". Brain Dev. 16 Suppl: 81–5. PMID 7726385.
- ↑ 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.
- ↑ Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE; et al. (2006). "Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia". Metabolism. 55 (1): 78–83. doi:10.1016/j.metabol.2005.07.009. PMID 16324923.
- ↑ Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS (2014). "Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas". JAMA Intern Med. 174 (10): 1605–12. doi:10.1001/jamainternmed.2014.3293. PMC 4878670. PMID 25179404. Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13
- ↑ Maitra SR, Wojnar MM, Lang CH (2000). "Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis". Shock. 13 (5): 379–85. PMID 10807013.
- ↑ Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W (2016). "Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life". Eur J Endocrinol. 174 (2): 177–86. doi:10.1530/EJE-15-0775. PMID 26563979.
- ↑ Galati SJ, Rayfield EJ (2014). "Approach to the patient with postprandial hypoglycemia". Endocr Pract. 20 (4): 331–40. doi:10.4158/EP13132.RA. PMID 24246338.
- ↑ Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P (2009). "Autoimmune forms of hypoglycemia". Medicine (Baltimore). 88 (3): 141–53. doi:10.1097/MD.0b013e3181a5b42e. PMID 19440117.