Hypoglycemia physical examination

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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.

Respiration

• Disturbed breathing may be present

Skin

• Pallor

Eyes

• Staring, "glassy" look
• Dilated pupils

Extremities

• Cyanosis may be present in newborns

Neurologic

• 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.