endocrine and metabolic disorders
Hypoglycemia
Treatment of Hypoglycemia
Oral sugar or IVdextrose Sometimes parenteralglucagon Immediate treatment of hypoglycemia involves provision of glucose. Individuals at risk for hypoglycemia should haveglucagonordasiglucagonat home and elsewhere, and household members and trusted others should be instructed on management of hypoglycemic emergencies. In patients treated with glucose-lowering medications (insulinor sulfonylureas), a plasma glucose level < 70 mg/dL (< 3.8 mmol/L) is considered hypoglycemia and should be treated to avoid further decreases in blood glucose and consequences of hypoglycemia. Patients who are able to eat or drink can drink juices, sucrose water, or glucose solutions; eat candy or other foods; or chew on glucose tablets when symptoms occur. The rule of 15s should be followed for treatment of hypoglycemia. Typically, 15 g of glucose or sucrose should be ingested. Patients should check their glucose levels 15 minutes after glucose or sucrose ingestion and ingest an additional 15 g if their glucose level is not>80 mg/dL (> 4.4 mmol/L). After glucose levels improve to > 80 mg/dL, a snack containing complex carbohydrates and protein may be ingested to prevent the glucose level from dropping again. Adults and children who are unable to eat or drink can be givenglucagon0.5 mg (<25 kg body weight) or 1 mg (≥25 kg) subcutaneously or intramuscularly.Glucagonnasal spray, 1 actuation (3 mg) once in 1 nostril may be used in adults and in children≥4 years.Dasiglucagon, 0.6 mg once subcutaneously (available in an autoinjector), may also be used in adults and in children≥6 years. In infants and younger children who are hospitalized, hypoglycemia is managed by giving a 2 to 3 mL/kg IV bolus of 10%dextrosesolution. Adults or older children who are hospitalized can be treated with 50%dextrose, 50 to 100 mL IV bolus, with or without a continuous infusion of 5 to 10%dextrosesolution until symptoms resolve. The efficacy ofglucagondepends on the size of hepatic glycogen stores;glucagonhas little effect on plasma glucose in patients who have been fasting or who are hypoglycemic for long periods. Hyperglycemia may follow hypoglycemia either because too much sugar was ingested or because hypoglycemia caused a surge in counter-regulatory hormones (glucagon,epinephrine,cortisol, growth hormone). Hypoglycemia in patients not takinginsulinor a sulfonylurea should also be corrected with oral sugar, IVdextroseorglucagon. Underlying disorders causing hypoglycemia must also be treated. Islet cell and non–islet cell tumors must first be localized, then removed by enucleation or partial pancreatectomy; about 6% recur within 10 years.Diazoxideandoctreotidecan be used to control symptoms while the patient is awaiting surgery or when a patient refuses or is not a candidate for a procedure. Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPH) is most often a diagnosis of exclusion after an islet cell tumor is sought but not identified.Diazoxideoroctreotidehas been used, and partial pancreatectomy may be required for refractory cases. Patients with hypoglycemia following gastric bypass can sometimes be treated with frequent low carbohydrate meals, but other treatments such asacarboseto decrease the rate of postprandial glucose absorption and resultinginsulinresponse ordiazoxideto decreaseinsulinsecretion may be needed. Drugs that cause hypoglycemia, including alcohol, must be stopped. Treatment of hereditary and endocrine disorders, Acute Liver Failure , 