Hypoglycemia

Hypoglycemia, or abnormally low blood glucose, is a complication of several diabetes treatments. It may develop if the glucose intake does not cover the treatment. The patient may become agitated, sweaty, and have many symptoms of sympathetic activation of the autonomic nervous system resulting in feelings similar to dread and immobilized panic. Consciousness can be altered, or even lost, in extreme cases, leading to coma and/or seizures, or even brain damage and death. In patients with diabetes, this can be caused by several factors, such as too much or incorrectly timed insulin, too much exercise or incorrectly timed exercise (exercise decreases insulin requirements) or not enough food (actually an insufficient amount of glucose-producing carbohydrates in food). In most cases, hypoglycemia is treated with sugary drinks or food. In severe cases, an injection of glucagon (a hormone with the opposite effects of insulin) or an intravenous infusion of glucose is used for treatment, but usually only if the person is unconscious. In hospital, intravenous dextrose is often used.

Prehospital Care: Isotonic saline solution should be given as a bolus up to 1 L, depending on the patient's vital signs and other indicators of hypovolemia.

Prehospital Care: Treatment of hypoglycemia consists of correcting the glucose deficiency and directing further treatment to the underlying cause.

• EMS care generally consists of drawing serum glucose or Accucheck prior to administering D50 in the field. This procedure usually is performed in the case of an unconscious patient or a patient with altered mental status.

• Many advanced cardiac life support (ACLS)-trained and first responders are able to perform simple bedside glucose testing. This procedure should be part of the normal protocol for any EMS unit.

• When hypoglycemia is found and treated in the diabetic patient, the patient may awaken and not desire transport.

• Considering the multiple causes of a sudden episode of hypoglycemia in a patient with previously well-controlled diabetes, advising transport and ED evaluation is prudent.

Emergency Department Care:

• The initial approach should include the following: ABCs, intravenous (IV) access, oxygen, monitoring, and Accucheck. Administration of glucose as part of the initial evaluation of altered mental status often corrects hypoglycemia.

• Treatment should not be withheld while waiting for a laboratory glucose value. Because the brain uses glucose as its primary energy source, neuronal damage may occur if treatment of hypoglycemia is delayed.

• A hyperglycemic patient with an altered mental status may receive a bolus of glucose. This procedure is unlikely to harm the patient with high glucose; however, the delay in giving glucose to the hypoglycemic patient may be detrimental.

• If an Accucheck can be performed immediately, awaiting the results of this test (available within 1 minute) before deciding whether to administer glucose is reasonable.

• Once the diagnosis of hypoglycemia is made, search carefully for the cause in the previously healthy patient.

• In the diabetic patient, search diligently for the cause (eg, medication changes, dietary changes, new metabolic changes, recent illness, occult infection) of the episode.

Date: 2015-01-12; view: 720