Hypoglycemia - NYSORA

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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 symptomsAdrenergic symptoms
Blurred visionPalpitations
Unusal behaviorClamminess
ConfusionFeeling shaky or trembling
Altered mental status (like being drunk)
Loss of consciousness Tingling sensation
Pale skin color
Easily irritated, tearful, anxious, or moody

Management and prevention

Blood glucose, hypoglycemia, diaphoresis, normoglycemia, glucose level, dextrose, glucacon, insulin, ethanol, pituitary insufficiency, post-prandial hypoglycemia, islet cell tumors, immune hypoglycemia, infection, sepsis, non-pancreatic neoplasms, starvation, hypothyroidism, pheochromocytoma

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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