You are asked to see a 24 year old man in the emergency department for hypotension (80/40 mmHg) and hypoglycaemia (2.2mmol/L) with associated drowsiness. He has a long-standing history of insulin dependant diabetes mellitus (IDDM) which has been well controlled until recently, when he was admitted for a short stay in hospital with diabetic keto acidosis (DKA).
a. List 4 likely causes of hypoglycaemia in this patient.
College Answer
a. List 4 likely causes of hypoglycaemia in this patient.
• Accidental or non accidental overdose of long acting insulin
• Sepsis
• Glucocorticoid deficiency
• Hypothyroidism
• Insulin secreting tumour
• Less likely: severe liver disease
Discussion
The causes of hypoglycaemia are protean. Here are just a few:
Drugs
|
Illness
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Pragmatically speaking, it is very rarely anything quite as exciting as an insulinoma.
Pragmatically speaking, it is very rarely anything quite as exciting as an insulinoma. A study of patients admitted with hypoglycaemia has identified several common causes, listed below and ordered from most to least common:
- Inadequate intake of carbohydrate (28%)
- Ingestion of alcohol (19%)
- Deliberate overdose of insulin (13%)
- Accidental overdose of insulin (6%)
- Strenuous exercise (7%)
References
UpToDate has a nice article on this for the paying customer.
Cryer, Philip E., Stephen N. Davis, and Harry Shamoon. "Hypoglycemia in diabetes." Diabetes care 26.6 (2003): 1902-1912.
Hart, S. P., and B. M. Frier. "Causes, management and morbidity of acute hypoglycaemia in adults requiring hospital admission." Qjm 91.7 (1998): 505-510.