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Hypoglycemia - Coggle Diagram
Hypoglycemia
DDX for Hypoglycemia
Lab artifact
Always rule this out FIRST
Serum sits on clot
Portable Blood Glucose Analyzers Increased Utilization
Extra-pancreatic neoplasia
large tumors
liver is a common site
Sepsis
systemic infection
peripheral utilization
decreased food intake
bacterial utilization?
Insulin Excess
Iatrogenic: Insulin overdosage
Insulinoma
Gastrinoma G-cell tumors
Toxicity: Xylitol
Decreased Production/Availability
Hepatic failure (congenital/acquired)
Hypoadrenocorticism
“Puppy hypoglycemia” (toy breeds)
Young puppies
8-16 weeks
up to 6 months
toy breeds esp susceptibel
Limited glycogen stores
immature enzymes of gluconeogenesis
CS
weak
ataxic
collapse
seizures
Often associated with co-existing illnesses
vomiting
diarrhea
shipping
stress
Treatment
IV dextrose brings immediate response
Provide immediate glucose support
Correct underlying diseases
Provide adequate calories at frequent intervals
rare example of when fasting results in hypoglycemia in dogs
Normal, healthy dogs can be fasted for weeks without hypoglycemia occurring!
Uremia (rare)
Hypopituitarism (rare)
Glycogen storage diseases (rare)
Unproven ddx
Functional Hypoglycemia
Seen in working dogs associated with heavy exercise
Seizure, weakness or collapse in the field
DDx: Exercise-induced collapse!
Recovery is rapid
"Hunting dog hypoglycemia”
Pancreatic Neoplasia
Increased utilization
Pancreatic adenocarcinoma
Gastrinoma G-cell tumors
"insulinoma" Beta-cell tumors
Late pregnancy
Endocrine system response to hypoglycemia
Hypoglycemia suppresses insulin secretion
Hypoglycemia increases the counterregulatory hormones:
Glucagon, epinephrine and norepinephrine increase early
Cortisol and growth hormone increase later
Glucagon is the key hormone affecting recovery from acute hypoglycemia
hepatic glucose production increases within minutes
Hypoglycemia
Artifact
Increased utilization
Decreased production
Miscellaneous
Maintenance of Euglycemia
After eating, ingested fuels provide energy for 4-8 hrs
Between meals
fuel comes from endogenous sources
primarily hepatic production of glucose
Glycogenolysis (enough for 2-3 days)
Gluconeogenesis, from...
amino acids
lactate
glycerol
relies on a normally functioning endocrine system
Clinical Signs of Hypoglycemia
Signs related to neuroglycopenia (brain)
Lethargy
weakness
ataxia
bizarre behavior
blindness
seizures
coma
Glucose is the primary fuel used by the CNS
neurons require a continuous supply from the blood as little storage
Signs related to sympathoadrenal response (Epi, NE, cortisol)
Muscle tremors
nervousness
restlessness,
tachycardia
hunger
Often precede neuroglycopenic signs