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Hypoglycemia (blood glucose <3.9 mmol/L)





  • Sympathetic system activation: diaphoresis, tremor, tachycardia, anxiety, hunger

  • Neuroglycopenia: weakness, fatigue, altered mental status, coma



Differential diagnosis


  • Exogenous insulin

  • Critical illness/sepsis

  • Endocrine: Addison's disease, adrenal crisis, hypopituitarism

  • Insulin producing tumors

  • Fasting hypoglygemia: inherited liver/fatty acid oxidation enzyme deficiencies, drugs (ethanol, haloperidol)

  • Reactive (postprandial) hypoglycemia: idiopathic or enzyme deficiencies





  • Confirm glucose level

  • Treat: IV dextrose (D5W 50ml IV); glucagon 1-2mg IM if no IV access

  • Seizure precautions

  • Continue to monitor & treat until glucose levels stable

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