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Differential Diagnosis > Hypoglycemia > Flashcards

Hypoglycemia Flashcards

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1
Q

What are the general symptoms of hyperglycemia?

A

Polyuria, polydipsia, fatigue, blurred vision.

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2
Q

What is the main hormone that reduces blood sugar?

A

Insulin.

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3
Q

What is the role of glucagon?

A

Raises blood sugar by promoting glucose release and production.

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4
Q

What are 3 major differential diagnoses for hyperglycemia?

A

Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycemic State (HHS), Cushing’s Syndrome.

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5
Q

What condition is defined by high glucose, ketones, acidosis, and dehydration?

A

Diabetic Ketoacidosis (DKA).

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6
Q

What are Kussmaul respirations and what do they indicate?

A

Deep, labored breathing; sign of metabolic acidosis (seen in DKA).

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7
Q

What is the key difference in osmolality between DKA and HHS?

A

DKA = Normal to high osmolality; HHS = Very high osmolality.

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8
Q

Glucose >33 mmol/L with no ketones and pH >7.3 suggests?

A

HHS.

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9
Q

A patient with DKA may present with what lab findings?

A

Glucose >14 mmol/L, ketones, pH <7.3, metabolic acidosis.

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10
Q

Treatment for DKA?

A

IV access, fluid resuscitation, insulin, electrolyte correction.

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11
Q

Treatment for HHS?

A

IV fluids, insulin, electrolyte correction, treat underlying cause.

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12
Q

What endocrine disorder causes hyperglycemia due to excess cortisol?

A

Cushing’s Syndrome.

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13
Q

Pancreatitis, pancreatic cancer, and cystic fibrosis can lead to?

A

Hyperglycemia due to impaired insulin production.

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14
Q

What drugs can induce hyperglycemia?

A

Steroids (glucocorticoids), beta-agonists (e.g., salbutamol).

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15
Q

How do beta-agonists raise blood sugar?

A

Stimulate glycogenolysis and gluconeogenesis.

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16
Q

Define hypoglycemia based on glucose levels.

A

Blood glucose <4 mmol/L.

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17
Q

What are adrenergic symptoms of hypoglycemia?

A

Tremors, palpitations, anxiety, diaphoresis, hunger.

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18
Q

What are neuroglycopenic symptoms of hypoglycemia?

A

Confusion, dizziness, seizures, unconsciousness.

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19
Q

What is Whipple’s Triad?

A

Symptoms of hypoglycemia, low blood glucose, resolution with glucose intake.

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20
Q

What are 4 common causes of hypoglycemia?

A

Excess insulin, missed meals, alcohol, sepsis.

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21
Q

What is Alcohol-Induced Hypoglycemia (AIH)?

A

Liver prioritizes alcohol metabolism over glucose release, causing hypoglycemia.

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22
Q

Why does sepsis cause hypoglycemia?

A

Increased glucose use, impaired production, poor prognosis.

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23
Q

What adrenal condition can lead to hypoglycemia?

A

Adrenal insufficiency due to low cortisol.

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24
Q

How does liver disease cause hypoglycemia?

A

Impaired gluconeogenesis and glycogen storage, poor insulin clearance.

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25
Which meds cause hypoglycemia?
Beta blockers (mask symptoms), quinine (stimulates insulin release).
26
What is the hallmark lab profile of hypoglycemia?
Glucose <4 mmol/L, no ketones, normal pH/osmolality, rapid onset.
27
What history questions help differentiate hypo vs hyperglycemia?
Insulin use, last meal, alcohol intake, recent illness or infection.
28
What vitals may be altered in hypoglycemia?
Tachycardia, hypotension, altered LOC, diaphoresis.
29
What vitals may be altered in hyperglycemia?
Tachycardia, dry mucosa, hypotension, Kussmaul respirations.
30
What diagnostic tests confirm hypoglycemia?
Blood glucose <4 mmol/L, symptomatic relief with sugar.
31
What lab values support DKA?
Glucose >14 mmol/L, ketones, pH <7.3, low Na+, high K+.
32
What confirms HHS?
Glucose >33 mmol/L, no ketones, very high osmolality.
33
Which symptom suggests HHS over DKA?
Profound neurological symptoms (coma/confusion) with no acidosis.
34
How can adrenal insufficiency be confirmed?
Low cortisol levels, history of Addison’s or steroid withdrawal.
35
First BLS treatment step for a hypoglycemic patient who is alert?
Administer oral glucose if patient can swallow.
36
What ALS treatments are used for hypoglycemia?
Dextrose IV, Glucagon IM if no IV access.
37
When is glucagon contraindicated?
If the patient is malnourished, has pheochromocytoma, or is allergic.
38
When to consult BHP under the Hypoglycemia Medical Directive?
If repeat hypoglycemia occurs after max doses given.
39
What is the adult dose of D10W under ALS directive?
0.2 g/kg (2 mL/kg), max 10 g (100 mL).
40
What is the Glucagon dose if patient is ≥25 kg?
1 mg IM, once.
41
What do you do if patient is VSA and hypoglycemia is suspected?
Administer D10W or glucagon and continue resuscitation.
42
For DKA/HHS, what should you prioritize in a prehospital setting?
Oxygen, IV access, transport, monitor ECG, fluid support.
43
What drug classes could be contributing to current glucose status?
Steroids, beta-agonists (hyper); beta-blockers, insulin, sulfonylureas (hypo).
44
Pt has fruity breath, tachypnea, nausea, glucose 19 mmol/L. Diagnosis?
DKA.
45
Pt has AMS, dry skin, glucose 38 mmol/L, no ketones. Diagnosis?
HHS.
46
Pt has seizures, sweating, glucose 2.8 mmol/L. Likely cause?
Hypoglycemia.
47
Pt with cirrhosis, AMS, glucose 3.0 mmol/L. Likely cause?
Liver disease-induced hypoglycemia.
48
Pt with sepsis, hypotension, confusion, glucose 3.5 mmol/L. Likely diagnosis?
Sepsis-induced hypoglycemia.
49
Pt with hx of asthma on beta-agonists presents with glucose 20 mmol/L. Likely cause?
Medication-induced hyperglycemia.
50
Diabetic pt forgot insulin and has abdo pain, nausea, high glucose. Likely condition?
DKA.
51
What endocrine condition increases insulin resistance and glucose production?
Cushing’s Syndrome.
52
How does stress affect blood glucose?
Increases cortisol and glucagon → raises glucose.
53
Why can missed meals cause hypoglycemia?
Ongoing insulin without carbohydrate intake lowers glucose.
54
What lifestyle factors can help prevent Type 2 DM?
Diet, exercise, weight loss.
55
What BLS signs suggest altered LOA due to hypoglycemia?
Diaphoresis, confusion, seizure-like activity, normal skin perfusion.
56
What makes AIH (alcohol-induced) hypoglycemia unique?
Liver halts gluconeogenesis to metabolize alcohol, causing low sugar.
57
What critical vitals may point to DKA?
Tachypnea (Kussmaul), fruity breath, hypotension, tachycardia.
58
What do you give a hypoglycemic patient without IV access?
Glucagon.
59
A patient is diabetic, confused, hypotensive, febrile. Glucose 3.9 mmol/L. Top differential?
Sepsis-induced hypoglycemia.
60
How to confirm diagnosis of HHS in the field?
High glucose (>33), no ketones, severe dehydration, AMS.
61
What blood glucose level defines hypoglycemia for PCPs?
<4.0 mmol/L.
62
What is the first treatment for a conscious hypoglycemic patient able to swallow?
Oral glucose (chewable tablet, gel, juice, etc.).
63
What dose of oral glucose should be given?
Typically 15–20g, or as per BLS standard.
64
What should be reassessed 10 minutes after oral glucose?
Repeat glucose check and patient LOA.
65
What vital signs are commonly altered in hypoglycemia?
Tachycardia, hypotension, diaphoresis, altered LOA.
66
Can PCPs administer dextrose IV?
No – Dextrose is ACP scope.
67
When can a PCP administer glucagon?
If the patient is hypoglycemic and cannot take oral glucose due to decreased LOA and has no IV access.
68
What is the adult glucagon dose for a patient ≥25 kg?
1 mg IM, once.
69
What is the glucagon dose for patients <25 kg?
0.5 mg IM, once.
70
What must you check before giving glucagon?
Confirm glucose <4.0 mmol/L and rule out contraindications (e.g., allergy, pheochromocytoma).
71
Can PCPs treat hyperglycemia in the field with medications?
No – treatment is supportive (oxygen, fluids if hypotensive and authorized, transport).
72
What symptoms point to DKA/HHS?
Fruity breath, deep breathing (Kussmaul), vomiting, dehydration, altered LOA.
73
What is the priority management of suspected DKA/HHS for PCPs?
Oxygen, vital signs, IV access if authorized, rapid transport.
74
Is insulin administration within PCP scope?
No – insulin is ACP and hospital-level only.
75
Can PCPs administer fluids to hyperglycemic patients?
Only if authorized and hypotensive per local protocol or medical directive (varies by service).
76
What questions should a PCP ask when assessing altered LOA with suspected glycemic cause?
Diabetic history, last insulin/dose, last meal, recent illness, alcohol use.
77
What physical clues suggest hypoglycemia?
Sweating, tremors, anxiety, pallor, seizures, LOC changes.
78
What clues suggest hyperglycemia with DKA?
Dehydration, fruity odor, vomiting, abdominal pain, fast deep breathing.
79
How do you differentiate alcohol intoxication vs hypoglycemia?
Glucose test, odor, and response to glucose.
80
What tool helps rapidly confirm hypoglycemia vs stroke or overdose?
Glucometer.
81
Patient is conscious with glucose 3.2 mmol/L. Treatment?
Oral glucose.
82
Patient is unconscious with glucose 2.5 mmol/L, no IV. Treatment?
Glucagon 1 mg IM (≥25 kg) or 0.5 mg IM (<25 kg).
83
Patient had a seizure, is now postictal with glucose 3.0 mmol/L. Treatment?
Glucagon IM if unable to take oral glucose.
84
You’ve given glucagon. What next?
Monitor vitals and LOA; prepare for transport; reassess glucose after 10–15 mins.
85
What if glucose is still <4 mmol/L after glucagon?
Transport urgently and consult BHP if required.
86
What is the best indicator that hypoglycemia treatment is working?
Increasing LOA and glucose >4 mmol/L.
87
What if glucose is <2.0 mmol/L and patient is VSA?
Treat hypoglycemia per medical directive (glucagon if no IV), continue resuscitation.
88
What do PCPs monitor after treating glycemic issues?
Vitals, repeat glucose, changes in LOA.
89
Can PCPs administer a second dose of glucagon?
No – only one dose per protocol.
90
What if you suspect hypoglycemia but have no glucometer reading?
Treat presumptively if clinical signs present and diabetic history.
91
What three conditions commonly present with altered LOA and must be ruled out?
Hypoglycemia, stroke, opioid overdose.
92
What differentiates stroke from hypoglycemia?
Stroke = unilateral weakness/facial droop; hypoglycemia = bilateral weakness, tremors, diaphoresis.
93
What symptom helps differentiate opioid OD from hypoglycemia?
Pinpoint pupils and bradypnea (opioid); tremors and sweating (hypo).
94
What should you always rule out first in altered LOA per BLS?
Hypoglycemia.
95
Which glucose reading requires no PCP intervention?
>4 mmol/L with normal LOA.
96
When should you recheck glucose after treatment?
After 10–15 minutes or sooner if there’s a change in status.
97
What should you document post-treatment?
Pre/post glucose, treatment given, response, vitals, LOA, time of reassessment.
98
If patient refuses transport after hypoglycemia treatment, what must be ensured?
Glucose >4 mmol/L, normal LOA, able to eat, and informed refusal with full documentation.
99
Can you release a hypoglycemic patient on scene?
Only if protocol allows, patient meets refusal criteria, and no ongoing risks.
100
What do you do if a diabetic patient’s glucose is 7.0 mmol/L but they’re confused?
Rule out other causes of AMS – do not treat as hypoglycemia.

Differential Diagnosis (4 decks)

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