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Hypoglycemia: Differential Diagnoses & Workup
Updated: Nov 26, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Hypoglycemic agents (eg, insulin, oral hypoglycemic agents)
Drugs/toxins (eg, ethanol, salicylates, beta-blockers, pentamidine)
Endocrine disorders (eg, Addison disease, glucagon deficiency, carcinomas, extrahepatic tumors)
Hepatic disease (eg, cirrhosis, galactose intolerance, fructose intolerance, glycogen storage diseases)
Nutritional disorders (eg, prolonged starvation prior to anesthesia, protein calorie malnutrition, L-leucine-sensitive hypoglycemic defect in children, low-calorie ketogenic diet, renal disease)
Autoimmune disorders (eg, Graves disease)
Other (eg, Jamaican vomiting sickness, ingestion of ethanol-containing mouthwash or cologne [children], gastric surgery, potassium administration during periodic attacks of paralysis, excessive muscular activity, diarrhea [childhood])
CNS disorders
Psychogenic
Workup
Laboratory Studies
- Treatment and disposition of hypoglycemia are guided by the history and the clinical picture. Serum glucose should be measured frequently and used to guide treatment, because clinical appearance alone may not reflect the seriousness of the situation.
- Hypoglycemia is defined according to the following serum glucose levels:
- <50 mg/dL in men
- <45 mg/dL in women
- <40 mg/dL in infants and children
- If the cause of hypoglycemia is other than oral hypoglycemic agents or insulin in a diabetic patient, other lab tests may be necessary.
- C-peptide measurement: This measurement is elevated in insulinoma, normal or low with exogenous insulin, and elevated with oral sulfonylureas.
- Check liver function tests, serum insulin, and cortisol and thyroid levels.
- Search for a source of infection. Studies should be considered to rule out the possibility of a concurrent occult infection contributing to the new hypoglycemic episode.
- Complete physical examination
- Chest radiograph
- Urinalysis
- Blood cultures
Imaging Studies
- Performing an abdominal CT scan or an ultrasound to rule out an abdominal tumor may be appropriate in the patient with new-onset hypoglycemia and no clear etiology.
- In diabetic patients presenting with hypoglycemia, perform a chest radiograph to rule out infection.
Other Tests
- Plasma glucose overnight fasting - <60 mg/dL (3.33 mmol/L)
- Plasma glucose 72-hour fasting
- <45 mg/dL (2.5 mmol/L) for females
- <55 mg/dL (3.05 mmol/L for males
- Oral glucose tolerance - <50 mg/dL (<2.78 mmol/L)
- Insulin radioimmunoassay - Insulin levels elevated if islet cell tumor present
More on Hypoglycemia |
| Overview: Hypoglycemia |
 Differential Diagnoses & Workup: Hypoglycemia |
| Treatment & Medication: Hypoglycemia |
| Follow-up: Hypoglycemia |
| References |
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References
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Bourcigaux N, Arnault-Ouary G, Christol R, et al. Treatment of hypoglycemia using combined glucocorticoid and recombinant human growth hormone in a patient with a metastatic non-islet cell tumor hypoglycemia. Clin Ther. Feb 2005;27(2):246-51. [Medline].
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Leiken JB, Palouchek FP. Poisoning and Toxicology Handbook. 1996-1997.
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Paterson KR, Paice BJ, Lawson DH. Undesired effects of biguanide therapy. Adverse Drug React Acute Poisoning Rev. 1984;3(3):173-82. [Medline].
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Further Reading
Keywords
hypoglycemia, low blood sugar, low glucose, glucopenia, decrease in the blood glucose level, insulinoma, coma, cardiac dysrhythmia, confusion, convulsions, diabetes, non–insulin-dependent diabetes, oral hypoglycemics, islet cell tumor, extrapancreatic tumor,insulin, palpitations, nausea, sweating, anxiety, diabetes mellitus type 1, diabetes mellitus type 2
