Hypoglycemia physical examination: Difference between revisions

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==Overview==
==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.
Main signs of hypoglycemia are [[tachycardia]] and [[Ventricular arrhythmias|ventricular arrhythmia]]. Neurological manifestations include altered [[Mental status examination|mental status]], [[hypotonia]], focal or general motor deficit and [[Jerk|jerks]]. Neonatal hypoglycemia signs include [[large for gestational age]],[[Hepatomegaly| hepatomegaly]] in [[Beckwith-Wiedemann syndrome]] and [[Glycogen storage disease|glycogen storage diseases]]. [[Ambiguous genitalia|Ambiguous genitalia,]] [[hypertension]], [[hyponatremia]], and [[hyperkalemia]] are found in [[21-hydroxylase deficiency|congenital adrenal insufficiency]].


== Physical examination ==
== Physical examination ==


===Appearance===
===Appearance===
* [[Macrosomia]] in [[infancy]] usually indicates [[congenital hyperinsulinism|hyperinsulinism]].
* [[Macrosomia]] in [[infancy]] may indicate [[congenital hyperinsulinism|hyperinsulinism]].<ref name="pmid24685363">{{cite journal| author=Brutsaert E, Carey M, Zonszein J| title=The clinical impact of inpatient hypoglycemia. | journal=J Diabetes Complications | year= 2014 | volume= 28 | issue= 4 | pages= 565-72 | pmid=24685363 | doi=10.1016/j.jdiacomp.2014.03.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24685363  }}</ref>
* 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.
* 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|stroke-like]] effects or a hard-to-define [[malaise]].


=== Vitals ===
=== Vitals ===
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==== Pulse ====
==== Pulse ====
* Rate: [[Tachycardia]] may be present.
* Heart rate: [[Tachycardia]] may be present.


*Rhythm: The pulse is usually regular  
*Rhythm: Pulse is usually regular.
*Ventricular arrhythmia is fatal if occurred.<ref name="pmid17404614">{{cite journal| author=Cryer PE| title=Hypoglycemia, functional brain failure, and brain death. | journal=J Clin Invest | year= 2007 | volume= 117 | issue= 4 | pages= 868-70 | pmid=17404614 | doi=10.1172/JCI31669 | pmc=1838950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17404614  }}</ref>
*[[Ventricular arrhythmias|Ventricular arrhythmia]] is fatal if occurred.<ref name="pmid17404614">{{cite journal| author=Cryer PE| title=Hypoglycemia, functional brain failure, and brain death. | journal=J Clin Invest | year= 2007 | volume= 117 | issue= 4 | pages= 868-70 | pmid=17404614 | doi=10.1172/JCI31669 | pmc=1838950 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17404614  }}</ref>


==== Respiration ====
==== Respiration ====
* Abnormal breathing may be present
* [[Tachypnea]]


===Skin===
===Skin===
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===Eyes===
===Eyes===
* Staring, "glassy" look
*[[Dilated pupils]]
*[[Dilated pupils]]


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*[[Cyanosis]] may be present in newborns
*[[Cyanosis]] may be present in newborns


=== Neurologic <ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155  }}</ref> ===
=== Neurologic ===
* Mental status may be altered
* [[Mental status]] may be altered<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155  }}</ref>
*[[Myoclonic jerk]]s
*[[Myoclonus]]
*[[Hypotonia]]
*[[Hypotonia]]
* [[Ataxia]]
* [[Ataxia]]
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* [[Hemiparesis]]
* [[Hemiparesis]]


=== Signs of neonatal hypoglycemia ===
=== Neonatal Physical examination ===
* Large for gestational age
* [[Large for gestational age]]<ref name="pmid24685363" />
 
* [[Beckwith-Wiedemann syndrome]] signs: [[hemihypertrophy]], [[hepatomegaly]], and [[macroglossia]]<ref name="pmid24275620">{{cite journal| author=Rozance PJ| title=Update on neonatal hypoglycemia. | journal=Curr Opin Endocrinol Diabetes Obes | year= 2014 | volume= 21 | issue= 1 | pages= 45-50 | pmid=24275620 | doi=10.1097/MED.0000000000000027 | pmc=4012366 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24275620  }}</ref>
* Beckwith-Wiedemann syndrome signs: hemihypertrophy, hepatomegaly and macroglossia.
* [[21-hydroxylase deficiency|Congenital adrenal insufficiency]]: [[ambiguous genitalia]], [[hypertension]], [[hyponatremia]], and [[hyperkalemia]]<ref name="pmid24854693">{{cite journal| author=Lang T| title=Neonatal hypoglycemia. | journal=Clin Biochem | year= 2014 | volume= 47 | issue= 9 | pages= 718-9 | pmid=24854693 | doi=10.1016/j.clinbiochem.2014.05.026 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24854693  }}</ref>
* Congenital adrenal insufficiency: ambiguous genitalia, hypertension, hyponatremia, and hyperkalemia.
* [[Hypopituitarism|Congenital hypopituitarism]]: [[Facial defect|Midline facial defects]] and [[micropenis]]
* Congenital hypopituitarism: Midline facial defects and micropenis.
* [[Glycogen storage disease|Glycogen storage diseases]]: [[Hepatomegaly|Hepatomegaly.]]
* Glycogen storage diseases: Hepatomegaly.


== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 20:38, 15 November 2017

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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

Vitals

Temperature

Pulse

Respiration

Skin

Eyes

Extremities

Neurologic

Neonatal Physical examination

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Lang T (2014). "Neonatal hypoglycemia". Clin Biochem. 47 (9): 718–9. doi:10.1016/j.clinbiochem.2014.05.026. PMID 24854693.