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.[1]
- 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.[2]
Respiration
Skin
Eyes
- Staring look
- Dilated pupils
Extremities
- Cyanosis may be present in newborns
Neurologic
- Mental status may be altered[3]
- Myoclonus
- Hypotonia
- Ataxia
- Incoordination
- Focal or general motor deficit
- Paralysis
- Hemiparesis
Neonatal Physical examination
- Large for gestational age[1]
- Beckwith-Wiedemann syndrome signs: hemihypertrophy, hepatomegaly, and macroglossia[4]
- Congenital adrenal insufficiency: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia[5]
- Congenital hypopituitarism: Midline facial defects and micropenis
- Glycogen storage diseases: hepatomegaly.
References
- ↑ 1.0 1.1 Brutsaert E, Carey M, Zonszein J (2014). "The clinical impact of inpatient hypoglycemia". J Diabetes Complications. 28 (4): 565–72. doi:10.1016/j.jdiacomp.2014.03.002. PMID 24685363.
- ↑ 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.
- ↑ Rozance PJ (2014). "Update on neonatal hypoglycemia". Curr Opin Endocrinol Diabetes Obes. 21 (1): 45–50. doi:10.1097/MED.0000000000000027. PMC 4012366. PMID 24275620.
- ↑ Lang T (2014). "Neonatal hypoglycemia". Clin Biochem. 47 (9): 718–9. doi:10.1016/j.clinbiochem.2014.05.026. PMID 24854693.