Chemical Pathology 16 - Hypoglycaemia Flashcards Preview

Year 5 Pathology ICSM - DM me for full access > Chemical Pathology 16 - Hypoglycaemia > Flashcards

Flashcards in Chemical Pathology 16 - Hypoglycaemia Deck (18)
Loading flashcards...
1

How should hypoglycaemia be managed if the patient is alert and oriented?

Juice and a sandwich
Continuous monitoring and treat cause

2

How should hypoglycaemia be managed if the patient is drowsy, but not unconscious?

Bucchal glucose (this bypasses 1st pass metabolism)
Continuous monitoring and treat cause

3

How should hypoglycaemia be managed if the patient is unconscious or has a reduced swallow reflex?

IV glucose 20%
Continuous monitoring and treat cause

4

What are the possible symptoms of hypoglycaemia?

Adrenergic symptoms - tremors and sweating
Neuroglycopaenic symptoms - somnolence and confusion
None - in some type 1 diabetic

5

What is the body's physiological response to hypoglycaemia, and which of these responses if the first?

1st - reduced insulin
Then catecholamine release (ACTH, cortisol and GH increase, causes adrenergic symptoms) and increased glucagon

6

Recall the effects of glucagon

Directly:
1. Decreases peripheral glucose uptake
2. Increases glycogenolysis
3. Increases gluconeogenesis in the liver and kidneys
4. Increases lipolysis
This then leads to:
1. Increased glucose
2. Inceased free fatty acids
Fatty acids undergo beta oxidation --> ketones

7

What is the best measure of glucose?

Venous glucose (way better than capillary)

8

Recall 6 differentials for the cause of hypoglycaemia in a NON-diabetic patient

1. Critically unwell pt
2. Organ failure
3. Hyperinsulinism
4. Drugs
5. Extreme weight loss
6. Factitious

9

Recall 5 differentials for the cause of hypoglycaemia in diabetic patients

1. Medications - these iatrogenically reduce glucose
2. Inadequate CHO intake (T1D especially)
3. Impaired awareness (eg EtOH)
4. Exercise
5. In presence of autoimune conditions eg Addissons

10

What class of drug is gliclazide?

Sulphonylurea

11

Which 2 classes of oral diabetic drug are most likely to cause a hypo?

Sulphonylureas (eg gliclazide)
GLP-1 agents

12

Recall 3 non-diabetes drugs that can cause a hypo

Beta blockers (impair adrenergic response so have impaired awareness of symptoms)
Salicylates - impair regulation of glucose
Alcohol

13

In a neonate with hypoglycaemia but no ketones, what is the likely diagnosis?

Inborn error of fatty acid metabolism

14

Recall 3 possible causes of hyperinsulinaemic hypoglycaemia

1. Insulinoma (islet cel tumour)
2. Drugs (eg insulin/ sulphonylurea)
3. Islet cell hyperplasia

15

Recall 3 causes of islet cell hyperplasia in the neonate

1. Infant of a diabetic mother
2. Beckworth Wiedmann syndrome
3. Nesidioblastosis

16

How can non-islet cell tumours cause hypoglycaemia?

This is a RARE case - most likely to occur in mesothelioma/ carcinoma of the lung
These tumours secrete 'big IGF-2' (paraneoplastic syndrome) which binds to both IGF-1 and insulin receptors
In this case, insulin and C peptide will both be low

17

What are the 4 first basic biochemical tests that should be done in hypoglycaemia investigation?

1. Glucose
2. Insulin
3. C peptide
4. Drug screen

18

Recall 5 advanced biochemical tests that can be used in investigating a hypoglycaemia

Ketones and FFAs
IGF studies
Ammonia
Lactate
Inborn error of metabolism screen

Decks in Year 5 Pathology ICSM - DM me for full access Class (85):