Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. The symptoms of Whipple's triad have been used to describe hypoglycemia since 1938. For the Whipple triad, the practitioner must first recognize hypoglycemia symptoms, obtain low blood glucose, and finally, demonstrate immediate relief of symptoms by the correction of the low blood glucose after treatment. This activity reviews the evaluation and management of hypoglycemia and highlights the interprofessional team's role in educating patients with this condition about follow up care.
Hypoglycemia is often defined by a plasma glucose concentration below 70 mg/dL; however, signs and symptoms may not occur until plasma glucose concentrations drop below 55 mg/dL. The symptoms of Whipple's triad have been used to describe hypoglycemia since 1938. For Whipple's triad, the practitioner must first recognize symptoms of hypoglycemia, then obtain low blood glucose, and finally, demonstrate immediate relief of symptoms by the correction of the low blood glucose with glucose treatment. Glucose is the primary metabolic fuel for the brain under physiologic conditions. Unlike other tissues of the body, the brain is very limited in supplying its glucose. Expectedly, the brain requires a steady supply of arterial glucose for adequate metabolic function. Potential complications can arise from an interruption in the glucose supply. As such, protective mechanisms to guard against low serum blood glucose (hypoglycemia) have evolved in the body.
textbook of symptoms and physical sign by golwalla
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The clinical manifestations of hypoglycemia can be classified as either neuroglycopenic or neurogenic. Neuroglycopenic signs and symptoms are signs and symptoms that result from direct central nervous system (CNS) deprivation of glucose. These include behavioral changes, confusion, fatigue, seizure, coma, and potential death if not immediately corrected. Neurogenic signs and symptoms can either be adrenergic (including tremors, palpitations, anxiety) or cholinergic (including hunger, diaphoresis, paresthesias). Neurogenic symptoms and signs arise from sympathoadrenal involvement (either norepinephrine or acetylcholine release) in response to perceived hypoglycemia.
Severe insulin reactions may be proven fatal, so it is essential to contact EMS immediately when an individual is disoriented or unconscious. The patients with diabetes should also reach out to their clinicians if they begin to experience frequent hypoglycemic episodes, as they may need to have adjustments made to their medication regimen, meal plans, or even their exercise/activity regimen. Non-diabetic individuals who show signs or symptoms of hypoglycemia should contact their clinician to further evaluate their situation. Severe or prolonged hypoglycemia can be life-threatening, and in patients with diabetes, there is a correlation with increased mortality. In non-diabetic individuals experiencing reactive hypoglycemia, the prognosis is good.
Patient education remains a pivotal component in the prevention of hypoglycemic episodes. Focus on preventing hypoglycemia should include patient education on signs and symptoms that constitute hypoglycemia and early recognition of these signs and symptoms. Patients may also need counseling on meal plans and exercise to manage their condition better.
Non-adherence to medication or diet is the most common cause of treatment failure. Patients should monitor themselves for signs or symptoms of hypoglycemia and always have sources of glucose (for example, hard candy, fruit juice) immediately available. Developing programs to educate healthcare staff has also been shown to provide better outcomes. Teaming up with local pharmacies or grocery stores can help overcome some of the barriers often encountered by patients with diabetes.
A thorough evaluation of vitamin B12 deficiency should include a complete history and physical with an increased emphasis on gastrointestinal (GI) and neurologic findings. B12 deficiency manifests as macrocytic anemia, and thus, the presenting symptoms often include signs of anemia, such as fatigue and pallor. Due to the increased hemolysis caused by impaired red blood cell formation, jaundice may also be a presenting symptom. Therefore, a thorough dermatologic exam may also be helpful. Other presenting complaints may include peripheral neuropathy, glossitis, diarrhea, headaches, and neuropsychiatric disturbances.
Physical Diagnosis A Textbook of Symptoms & Physical Signs by Rustom Jal Vakil, Aspi F Golwalla (Highly Recommended) (Buy from Amazon/ Flipkart)I have read many books on clinical medicine and this book is unarguably the best book of the lot. A most detailed description of signs and symptoms given in any book. No book matches this for the signs and symptoms part. Highly recommended for the students has enough time to read this extremely detailed book. A book cannot get better than this.
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