Learning objectives
- Recognize signs and symptoms of hypoglycemia
- Manage and prevent hypoglycemia
Definition and mechanism
- Hypoglycemia is a fall in blood sugar to levels below normal, typically below 70 mg/dL or 3.9 mmol/L
- Hypoglycemia during general anesthesia is rarely reported in the general population
- May cause cerebral damage
Signs and symptoms
- Diaphoresis is a marked sign of hypoglycemia
- Other symptoms are usually masked under anesthesia
- In the awake patient, hypoglycemia is characterized by neuroglypenic and adrenergic symptoms
| Neuroglycopenic symptoms | Adrenergic symptoms |
|---|---|
| Dizziness | Tachycardia |
| Blurred vision | Palpitations |
| Headache | Diaphoresis |
| Unusal behavior | Clamminess |
| Confusion | Feeling shaky or trembling |
| Altered mental status (like being drunk) | Hunger |
| Seizures | Nausea |
| Loss of consciousness | Tingling sensation |
| Coma | Pale skin color |
| Easily irritated, tearful, anxious, or moody |
Management and prevention
Keep in mind
- Monitor blood glucose levels closely in starved patients with a history of significant alcohol intake as anesthesia masks cognitive dysfuntion
Suggested reading
- Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
- Kalra S, Bajwa SJ, Baruah M, Sehgal V. Hypoglycaemia in anesthesiology practice: Diagnostic, preventive, and management strategies. Saudi J Anaesth. 2013;7(4):447-452.
- Ackland, Gareth L. PhD, FRCA; Smith, Megan MBBS; McGlennan, Alan P. FRCA. Acute, Severe Hypoglycemia Occurring During General Anesthesia in a Nondiabetic Adult. Anesthesia & Analgesia: August 2007 – Volume 105 – Issue 2 – p 553-554.
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