1. By Ahmad soliman abdul halim
Hypoglycemia By
Ahmad soliman abdul halim

2. Definition

3. Definition of hypoglycemia
Infant & child : < 47 mg/dl

4. pathophysiology

5. Pathophysiology In Fed State :
↑glucose→↑insulin secretion → ↑ glucose uptake into cells
Suppress lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis
In fast state :
↓glucose→↓insulin secretion → ↑ lipolysis , gluconeogenesis ,glycogenolysis & ketogenesis With help of hormones

6. Causes

7. CAUSES & CLASSIFICATION OF HYPOGLYCEMIA
Hyperinsulinemia
(Negtive ketones)
Non Hyperinsulinemia state
(Postive ketones)
Idm
Psih
Presistent Hyperinulinemia
Insulinoma
Induced
Gluconeogensis & glycogen storage defect
Faod
Hormonal :gh & cortisol
Drugs
Idiopathic

8. Causes of hypoglycemia
(HYPERINSULINISM)
HYPERINSULINISM
(No ketonuria)
IDM
PSIH
Congenital hyperinsulinism
Insulinoma
BWS
Factitious

9. Causes of hypoglycemia
(HYPERINSULINISM)
HYPERINSULINISM
(No ketonuria)
Congenital hyperinsulinism
Beckwith-Wiedemann Syndrome

10. Causes of hypoglycemia
( NON HYPERINSULINISM)
Gluconeogenesis & glycogen storage defect
(ketonuria)
GSD I,III,IV,IX
Fructose 1,6 Diphosphatase
Pyruvate carboxlyse
Galactosemia

11. Causes of hypoglycemia
( NON HYPERINSULINISM)
Gluconeogenesis & glycogen storage defect
(ketonuria)
glycogen storage defect

12. Causes of hypoglycemia ( NON HYPERINSULINISM)
Fatty acid oxidation defect
Ketogensis defect
(No ketonuria)

13. Causes of hypoglycemia ( NON HYPERINSULINISM)
Hypopituitarism
Addison
Hormonal defect
( ketonuria)

14. Causes of hypoglycemia ( NON HYPERINSULINISM)
Drug induced
(ketonuria)

15. Causes of hypoglycemia ( NON HYPERINSULINISM)
Ketotic hypoglycemia

16. Clinical

17. Clinical picture of Hypoglycemia

18. approach

19. CLINICAL APPROACH 1 4 2 is the case in acute attack or not? 3
Confirm The Diagnosis Of Hypoglycemia
By Lab Or History Of Proved Pervious Attacks 2
is the case in acute attack or not? 3
How to deal with the case in between acute attack?
review your collected data 4

20. How to deal with case with acute attack?
Obtain Urine Or Blood Sample For Ketones,ABG
Ketones present , Acidosis :
suspect
Hormonal deficiency
Gluconeogensis & glycogen defects
Ketotic (idiopathic hypoglycemia)
IF YOU CAN DO THIS GO TO THE NEXT STEP
Ketones absent, normal ABG:
suspect
hyperinsulinism or FAOD
Try to obtain serum insulin(<5,100uU/ML) , if not elevated review metabolic screen ,if negative review extended metabolic screen
Obtain serum cortisol & GH, lactate (10,5ug/dl)

21. 1 2 3 How to deal with case NOT IN acute attack? Careful history for
Symptoms in relation to meals
Drug history
Other neurological symptoms
Salt craving
Family history of unexplained sibling death 2
Examine for
Stature
Skin pigmentation
Hepatomegally
Neurological examination 3
Admit to hospital for provocative tests
24hrs fast under careful observation: when symptoms provoked , proceed as step 2

22. Review your data Postive routine or EMS for FFA Elevated serum insulin
KETONES IN URINE OR BLOOD , ACIDOSIS
NO KETONES IN URINE OR BLOOD , NORMAL ABG
Postive routine or EMS for FFA
Elevated serum insulin
Elevated lactate
Normal lactate
>5uu
>100uu
Exogenous hyperinsulinism
Endogenous hyperinsulinism
Enzyme study + liver biopsy
Hormonal assay (negative)
Enzyme study + liver biopsy
Ketotic hypoglycemia is diagnosis of exclusion
Drug review
Rview onset
Image if insulinoma

23. treatment

24. TREATMENT