Page 466 - Medicine and Surgery

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462 Chapter 11: Endocrine system

and can cause hypoglycaemia in diabetic patients. Rare sent but treatment should not be delayed. Other tests
causes include insulinomas (see page 222) and Addison’s may be required to identify the underlying cause.
disease (see page 440).
Management
Clinical features This is a medical emergency and requires immediate
Patients become irritable, pale, weak and sweaty. In pa- treatment.
tients who have regular hypoglycaemic episodes and In conscious patients the blood sugar can be raised by
in autonomic neuropathy the awareness of symptoms oral administration of a sugary drink. This should be
is reduced. Untreated the condition progresses to con- followed by a more complex carbohydrate to prevent
fusion, seizures and coma. Prolonged or severe hypo- a further rebound hypoglycaemia.
glycaemia risks permanent neurological damage and Inunconsciouspatientsorthoseunabletotolerateoral
death. fluids blood sugar can be raised by administration of
glucose gel to the gums (e.g. Hypostop), intravenous
Investigations dextrose or intramuscular glucagon.
The diagnosis can be confirmed on bedside blood sugar Further management depends on severity and the un-
testing, a formal laboratory glucose sample should be derlying cause.