Diagnostic Considerations
Because the consequences of hypoglycemia can be devastating and an antidote is readily available, diagnosis and treatment must be rapid in any patient with suspected hypoglycemia, regardless of the cause. Patients with no previous history of hypoglycemia require a complete workup to find a potentially treatable disease.
Careful consideration should be given to all diabetic patients presenting with hypoglycemia. New medications, activity changes, and infection should be considered. Early in the course of non–insulin-dependent diabetes, patients may experience episodes of hypoglycemia several hours after meals. The symptoms generally are brief and respond spontaneously.
Conditions such as 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) can also cause hypoglycemia.
The following should also be considered when evaluating a patient with hypoglycemia:
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Hepatic disease: (eg, hepatic failure, cirrhosis, galactose intolerance, fructose intolerance, glycogen storage diseases) [21]
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Transient ischemic attacks
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Cardiac dysrhythmia
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Endocrine disorders (eg, pheochromocytoma, Addison disease, glucagon deficiency, carcinomas, extrahepatic tumors)
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Substance abuse (eg, cocaine, ethanol, salicylates, beta-blockers, pentamidine)
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Hypoglycemic agents (eg, insulin, oral hypoglycemic agents)
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Nutritional disorders (eg, prolonged starvation before anesthesia, protein calorie malnutrition, L-leucine-sensitive hypoglycemic defect in children, low-calorie ketogenic diet, renal disease)
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Autoimmune disorders (eg, Graves disease)
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Central nervous system (CNS) disorders
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Psychogenic
Differential Diagnoses
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Diagnostic algorithm. A systematic approach is often required to establish the true cause of hypoglycemia, using an algorithmic approach.
