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Drug-induced Hypoglycemia

Drug Induced Hypoglycemia


Presentation

  • Acute mountain sickness (AMS) can present with a wide variety of symptoms in unacclimatized persons who rapidly ascend to altitudes 2500 m.[ncbi.nlm.nih.gov]
  • […] significant morbidity and mortality in patients with diabetes or hyperglycemia. 6 , 7 In a systemic review of 448 publications describing drug-induced hypoglycemia, 8 90% of reported cases were classified as severe hypoglycemia in which symptoms were present[spectrum.diabetesjournals.org]
  • Patients presenting with hypoglycemia due to ingestion of a first-, second-, or third-generation hypoglycemic agent will have drug present in serum greater than the minimum effective concentration (see Reference Values).[mayomedicallaboratories.com]
Pallor
  • Clinical features : 1) General signs and symptoms: Dizziness, blurred vision, pallor, nausea, and light-headedness. 2) Perspiration, palpitations, tremor, hunger, anxiety, and profuse perspiration; these are caused by sympathetic stimulation (starting[empendium.com]
  • Signs of hypoglycemia • Common signs of hypoglycemia include : 1. diaphoresis and pallor. 2.[slideshare.net]
  • […] include cognitive impairment, behavioral/personality changes, difficulties speaking, dizziness, blurred vision, weakness, incoordination, hemiplegia, arrhythmias, seizures, coma, and even death. 38-39 Common signs of hypoglycemia include diaphoresis and pallor[ahcmedia.com]
Hypothermia
  • We assume that antipsychotic drug-induced hypoglycemia and hypothermia are underdiagnosed. Antipsychotic drugs are, however, widely used and these rare adverse-effects may occur in the clinical practice.[ncbi.nlm.nih.gov]
  • Loss of consciousness may be accompanied by bilateral plantar reflex, muscle tension, hypothermia. In the course of severe hypoglycemia may also appear unusual symptoms.[openaccessjournals.com]
Goiter
  • A diffuse goiter was noted, while proptosis, pretibial myxedema, and acropachy were absent. Her pulse rate 80/min, blood pressure 124/80 mm Hg, respiratory rate 20/min, and temperature 99 F.[cjhr.org]
Incontinence
  • There were no signs of head injury, tongue bite from convulsions or urinary incontinence. Initial rapid diagnostic tests revealed the presence of hypoglycemia; her capillary plasma glucose levels were too low to be detectable by glucometer.[cjhr.org]
Urinary Incontinence
  • There were no signs of head injury, tongue bite from convulsions or urinary incontinence. Initial rapid diagnostic tests revealed the presence of hypoglycemia; her capillary plasma glucose levels were too low to be detectable by glucometer.[cjhr.org]
Confusion
  • These similarities can lead to confusion in the diagnosis of hypoglycemia versus AMS, particularly for diabetics ascending to altitude.[ncbi.nlm.nih.gov]
  • Signs include Hunger Shakiness Dizziness Confusion Difficulty speaking Feeling anxious or weak In people with diabetes, hypoglycemia is often a side effect of diabetes medicines. Eating or drinking something with carbohydrates can help.[icdlist.com]
  • […] inhibitors Metformin when used with sulfonylureas Pentamidine Quinidine Quinine Sulfonylureas Symptoms Return to top Anxiety Hunger Irritability Nightmares Palpitations Shakiness Sweating Symptoms of long-term (chronic) hypoglycemia can include: Coma Confusion[pacificschoolserver.org]
  • , nausea, and light-headedness. 2) Perspiration, palpitations, tremor, hunger, anxiety, and profuse perspiration; these are caused by sympathetic stimulation (starting in patients with blood glucose levels of approximately 3.3 mmol/L [60 mg/dL]). 3) Confusion[empendium.com]
  • She is pleasant and slightly confused, although she can be reoriented. Her daughter, who accompanied her to the hospital, says this is her baseline state.[americannursetoday.com]
Seizure
  • The patient suffered from severe and protracted hypoglycaemia, complicated by a tonic–clonic seizure 7 days after escalation to therapeutic co-trimoxazole. Endogenous hyperinsulinaemia was confirmed and was attributed to co-trimoxazole use.[casereports.bmj.com]
  • Patients can be asymptomatic or have symptoms such as dizziness, fatigue, emotional lability, seizures and coma. Hypoglycemia can result from a variety of etiologies; this patient suffered from drug-induced hypoglycemia.[synapse.ucsf.edu]
  • […] is clinically defined as a serum glucose concentration low enough to cause the signs and symptoms differentiated in Table 1 . 1 – 4 Depending on the severity, hypoglycemic symptoms include irritability, impaired concentration, neurological deficits, seizures[spectrum.diabetesjournals.org]
  • Differential Diagnosis • Neurologic: CVA/TIA, seizure disorder • Drug/alcohol intoxication • Psychosis, depression 65.[slideshare.net]
  • Hunger Headaches Irritability Pounding heart ; racing pulse Pale skin Sweating Trembling Weakness Anxiety Without treatment, you might get more severe symptoms, including: Poor coordination Poor concentration Numbness in mouth and tongue Passing out Seizures[webmd.com]
Dizziness
  • Signs include Hunger Shakiness Dizziness Confusion Difficulty speaking Feeling anxious or weak In people with diabetes, hypoglycemia is often a side effect of diabetes medicines. Eating or drinking something with carbohydrates can help.[icdlist.com]
  • Clinical features : 1) General signs and symptoms: Dizziness, blurred vision, pallor, nausea, and light-headedness. 2) Perspiration, palpitations, tremor, hunger, anxiety, and profuse perspiration; these are caused by sympathetic stimulation (starting[empendium.com]
  • Family members reported that after snorting cocaine and then using Valium pills earlier that day, the patient began reporting dizziness, confusion and difficulty speaking before going to his room to lie down.[synapse.ucsf.edu]
  • They include: fatigue headaches pale skin confusion dizziness irritability mood changes clumsy or jerky movements If a child shows any of the above signs or symptoms, they should see a doctor as soon as possible.[medicalnewstoday.com]
  • Blurred vision or changes in vision Dizziness, lightheadedness, or shakiness Fatigue and weakness Fast or pounding heartbeat Sweating more than usual Headache Nausea or hunger Anxiety, Irritability, or confusion How is non-diabetic hypoglycemia diagnosed[drugs.com]
Altered Mental Status
  • Severe hypoglycemia : Altered mental status that requires assistance of a third party to actively administer carbohydrates, glucagon, or take other corrective actions. This usually requires an active follow-up even with hospital admission.[empendium.com]
  • Answer and interpretation It is traditionally advocated that thiamine 100mg IV be given prior to administering a bolus of glucose to the patient with altered mental status.[lifeinthefastlane.com]
  • Drug-induced hypoglycemia is a significant adverse effect that should be included in the differential diagnosis of hypoglycemia and considered whenever patients present with altered mental status.[academic.oup.com]
  • His further hospital course was complicated by profound steroid-induced myopathy, severe chronic skin GVHD, tacrolimus-associated hemolytic uremic syndrome, and two self-limiting episodes of altered mental status changes, for which no medical cause could[nature.com]
  • The formal definition of hypoglycemia is a condition characterized by a reduction in either plasma glucose concentration or its tissue utilization to a level that may induce symptoms or signs such as altered mental status and/or sympathetic nervous system[touchendocrinology.com]
Neglect
  • BACKGROUND: The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.[ncbi.nlm.nih.gov]
  • Well worth a read of the full text: Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada Abstract Background The costs of drug-induced hypoglycemia are a critical but often neglected[community.diabetes.org]
  • Loading metrics Open Access Peer-reviewed Research Article Mathieu Boulin, Vakaramoko Diaby, Cara Tannenbaum x Published: September 20, 2016 Abstract Background The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based[journals.plos.org]
  • Substance abuse in young patients with type 1 diabetes: easily neglected in complex medical management. Intern Med J. 2005; 35(6):359-61. Ghitza UE, Wu LT, Tai B.[drugabuse.com]

Workup

  • Only those non-diabetic individuals with documented Whipple's triad should undergo evaluation and management of hypoglycemia 2 to avoid unnecessary workup and costs.[ahcmedia.com]
  • . • Some patients have symptoms but normal blood glucoses; they need no further workup, in spite of their insistence. 20.[slideshare.net]
Fasting Hypoglycemia
  • Fasting hypoglycemia Nesidioblastosis is a rare cause of fasting hypoglycemia in infants and an extremely rare cause in adults.[emedicine.medscape.com]
  • The 2 types of non-diabetic hypoglycemia are fasting hypoglycemia and reactive hypoglycemia. Fasting hypoglycemia often happens after the person goes without food for 8 hours or longer.[drugs.com]
  • The antibodies generally appear a few weeks following the initiation of the drug and may result in both postprandial and fasting hypoglycemia.[cjhr.org]
  • Alcohol consumption, especially binge drinking, can cause severe or even fatal hypoglycemia by halting gluconeogenesis and depleting hepatic glycogen. 6 Critical illnesses affecting the liver, heart, or kidneys can contribute to fasting hypoglycemia.[uspharmacist.com]
  • However, there are other causes of fasting hypoglycemia — which my old Oxford Handbook explains as: EXPLAINS H Ex ogenous drugs — insulin, oral hypoglycemics, quinine, chloroquine, beta-blocker overdose, valproate overdose, salicylate overdose, pentamidine[lifeinthefastlane.com]

Treatment

  • A case is described in which the oral hypoglycemic agent acetohexamide, instead of acetazolamide, was mistakenly self-administered for the prophylaxis and treatment of altitude illness.[ncbi.nlm.nih.gov]
  • Treatment Return to top You will be given glucose. The doctor will review your diabetes treatment plan to help prevent future problems. Outlook (Prognosis) Return to top The outlook is good if the hypoglycemia is promptly detected and treated.[pacificschoolserver.org]
  • The kind of treatment depends on why you have low blood sugar.[icdlist.com]
  • Treatment Top Acute Treatment 1. Mild hypoglycemia : Intake of fast-acting carbohydrates (eg, 10-15 g of glucose in tablets or gel) or foods/fluids (fruit juice, hard bar candy); this may be repeated when necessary.[empendium.com]

Prognosis

  • The prognosis is good, if the condition is treated in a prompt manner Drug-Induced Hypoglycemia can be prevented in non-diabetic individuals by avoiding drugs intended to reduce blood glucose levels, as well as through proper management of diet and exercise[dovemed.com]
  • Outlook (Prognosis) Return to top The outlook is good if the hypoglycemia is promptly detected and treated. However, long-term and repeated episodes of hypoglycemia may damage the brain and nerves.[pacificschoolserver.org]
  • Outlook (Prognosis) Untreated, Cushing disease can cause severe illness, even death. Removal of the tumor may lead to full recovery, but the tumor can grow back.[mclarenhealthplan.org]
  • Prognosis - Hypoglycemia- leucine-induced Like diabetes, there is no cure for reactive hypoglycemia, only ways to control it.[checkorphan.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • (Etiology) The direct cause of Drug-Induced Hypoglycemia is the unregulated use of one of several types of medications that cause blood sugar levels to drop.[dovemed.com]
  • Last Reviewed: December 19, 2017 Last Updated: January 22, 2017 Definition and Etiology Top Drug-induced hypoglycemia is a plasma glucose level regardless of symptoms of hypoglycemia.[empendium.com]
  • Hypoglycemia can result from a variety of etiologies; this patient suffered from drug-induced hypoglycemia. Sulfonylureas are medications used in patients with type-2 diabetes to increase the release of endogenous insulin.[synapse.ucsf.edu]

Epidemiology

  • JAMA 285 : 437 – 443 5 2000 Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.[academic.oup.com]
  • Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med 1991;90:450–9. Davis EA, Keating B, Byrne GC, et al.[guidelines.diabetes.ca]
  • Epidemiology of severe hypoglycemia in the diabetes control and complications trial. The DCCT Research Group. Am J Med 1991;90:450-459. 60. Allen C, et al. Risk factors for frequent and severe hypoglycemia in type 1 diabetes.[ahcmedia.com]
  • Epidemiology Hypoglycemia is common in type 1 diabetes, especially in patients receiving intensive therapy, in whom the risk of severe hypoglycemia is increased more than threefold.[slideshare.net]
Sex distribution
Age distribution

Pathophysiology

  • In this article, we review pertinent clinical information on the incidence of drug-induced hypoglycemia and discuss the underlying pathophysiological mechanisms involved.[spectrum.diabetesjournals.org]
  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test The metabolic and hormonal profiles of insulinoma and sulfonylurea-induced hypoglycemia are identical.[mayomedicallaboratories.com]
  • Considering the magnitude of this problem, it is imperative to understand the underlying pathophysiological mechanisms by which a non-antidiabetic drug can cause hypoglycemia.[jmedicalcasereports.biomedcentral.com]
  • Hypoglycemia in type 2 diabetes: Pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005;28:2948-2961. 52. Gangji AS, et al.[ahcmedia.com]
  • Not only should physicians be keenly aware of this potential iatrogenic complication but they should also be fully engaged in understanding the pathophysiological mechanisms.[f1000research.com]

Prevention

  • Prevention Return to top For people with diabetes, strict control of blood sugar is important.[pacificschoolserver.org]
  • Research: Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Ty... 1 Reply - 249 Views Posts: 7156 Joined: 10/30/09 Research: Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in[community.diabetes.org]
  • The prognosis is good, if the condition is treated in a prompt manner Drug-Induced Hypoglycemia can be prevented in non-diabetic individuals by avoiding drugs intended to reduce blood glucose levels, as well as through proper management of diet and exercise[dovemed.com]
  • Subsequently, the patient should consume complex (long-lasting) carbohydrates to prevent recurrent hypoglycemia (eg, bread, potatoes, cereal, nuts, peanuts).[empendium.com]
  • Now in its second edition, this popular and essential comprehensive resource provides a detailed analysis of how to identify, prevent, and manage drug-induced diseases. Edited by James E. Tisdale and Douglas A.[books.google.com]

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