Thursday, September 15, 2011

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Whipple's triad - hypoglycemia diagnosis and treatment

 DIAGNOSIS 
Hypoglycemia can be diagnosed by whipple's triad which consists of:
1) symptoms consistent with hypoglycemia,
2) a low plasma glucose concentration measured by an accurate method,
3) relief of the symptoms when the plasma glucose level is raised.

 SYMPTOMS 
Symptoms of hypoglycemia are:
1) Neuroglycopenic symptoms like behavioral changes, fatigue, seizures, altered consciousness,
2) Adrenergic symptoms like palpitations, tremors, anxiety,
3) Cholinergic symptoms like sweating, hunger and altered sensations

The cut off value for hypoglycemia is 70 mg/dL which is equal to 3.9 mmol/L.

 TREATMENT 
Relief of symptoms can be done by:
1) an initial 20 g of carbohydrate containing fluid or food can be given if the patient can tolerate orally,
2) I.V glucose 25 g bolus at 2 mg/kg/min followed by 10 g/hr. 250 mL of 10% dextrose is better than 50 mL of 50 % dextrose as there is less thrombophlebitis.
3) Glucagon 1 mg subcutaneously or intramuscularly works as rapidly as dextrose and is a good method when no I.V access is available and the patient is unconscious but it will not work in drunk patient.

Below is a great infographic from Healthline .
Effects of caffeine on the Body
Last reviewed on: 2 September 2015

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