Critical Care Medicine

Hypoglycemia

Hypoglycemia

1. Description of the problem

What every clinician needs to know

Hypoglycemia may be associated with mortality and neurologic complications such as seizures and coma.

Clinical features

It is uncertain what the clinical consequences from hypoglycemia are in ICU patients.

In diabetes patients, hypoglycemia is associated with:

  1. Diverse symptoms such as anxiety, palpitations, tremor, sweating, hunger and paresthesias.

  2. Neurologic symptoms such as behavioral changes, cognitive dysfunction, seizures and coma.

Key management points

  1. Stop insulin infusion.

  2. Administer glucose.

  3. Check blood glucose within 30-60 minutes.

2. Emergency Management

Emergency management steps

  1. Stop insulin infusion (and oral antidiabetic agents).

  2. Administer 10 to 20 mL Glucose 50% intravenously.

  3. Check blood glucose concentration within 30 to 60 minutes.

Drugs and dosages

Glucose 50%

3. Diagnosis

Establishing a specific diagnosis

Different cutoffs have been used in literature to define hypoglycemia in ICU patients. These range from lower than 81 mg/dL to lower than 40 mg/dL. Generally, blood glucose concentration below 60 mg/dL is considered to be hypoglycemia.

Normal lab values

Normal blood glucose: 80-110 mg/dL

Pathophysiology

Glucose is the obligate fuel for the brain. Glucose cannot be synthesized by the brain, and glycogen storage supplies last for only minutes. Low blood glucose will therefore result in brain damage.

Epidemiology

Tight blood glucose control in ICU patients is associated with an increased incidence of hypoglycemia and also with increased mortality, and may occur in up to 28% of patients.

What's the evidence?

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