hypoglycemia
Introduction
Introduction Hypoglycemia is a group of clinical syndromes caused by a low concentration of blood glucose (referred to as blood glucose) caused by various causes. Generally, it is hypoglycemia in adult plasma blood glucose concentration (measured by plasma true sugar, glucose oxidase method) <2.8 mmol/L, or whole blood glucose <2.5 mmol/L. The diagnostic criteria for hypoglycemia in children is 1.11 mmol/L lower than the adult value, but whether clinical symptoms appear or not, the individual differences are large. There are many causes of hypoglycemia, and the disease can be roughly divided into organic hypoglycemia, functional hypoglycemia, and reactive hypoglycemia.
Cause
Cause
Etiology classification
First, fasting (post-absorption) bottom blood glucose
(1) islet function hyperthyroidism
1. Insulinoma (pancreatic B cell tumor), adenoma, microadenomas. Adenocarcinoma.
2. Islet B cell proliferation.
3. Multiple endocrine neoplasia (WINJ type) with insulinoma.
4. Infant islet B cell proliferation (leucine sensitivity or insensitivity).
5. Pancreatic duct cell neonatal islets (Nesiclioblast OSIS).
(2) Endocrine-derived hypoglycemia: insufficient secretion of hormones against orange insulin
1. Pituitary dysfunction (Xihan syndrome).
2. Addison's disease.
3. Hypothyroidism.
4. Islet A cells have low function.
(3) Hepatogenic hypoglycemia
1. Acquired liver disease 1 severe hepatitis (viral, toxic), 2 advanced cirrhosis, 3 hepatic congestion (chronic heart failure, chronic constrictive pericarditis, Buaa-Chiari syndrome), 4 ascending intrahepatic bile duct Hepatitis, 5 advanced liver cancer.
2. Lack of liver enzymes
(1) Hepatic glycogen accumulation disease type I, III, VI, IX type 3.
(2) Hepatic gluconease deficiency: 1 fructose 1.6 stone diphosphatase deficiency, 2 pyruvate deuterase deficiency, 3 phosphoenol or pyruvate kinase lack.
(3) Hepatic glycogen synthase deficiency.
(4) Hereditary fructose intolerance.
(5) with lactoseemia.
(four) extra-pancreatic malignant neoplasms hypoglycemia
1. Tumor 1 fusiform sarcoma from mesodermal mesenchymal tissue, 2 leiomyosarcoma, 3 sarcoma, 4 liposarcoma, 5 stromal cell tumor, 5 neurofibromatosis, 1 reticulocyte sarcoma.
2. Adenocarcinoma 1 hepatocellular carcinoma, 2 cholangiocarcinoma, 3 gastric cancer, cecal colon cancer, 4 lung cancer, 5 breast cancer, 3 pancreatic cancer, 1 adrenal cortical cancer, 3 ovarian cancer.
3. Other tumors 1 type of cancer, 2 pheochromocytoma, 3 neuroblastoma and sympathetic ganglionoma, 4Wllm tumor.
(5) Nephrogenic hypoglycemia
Renal diabetes
2. Late stage of chronic renal failure
(6) Unexplained hypoglycemia
Autoimmune hypoglycemia
2. ketosis hypoglycemia
3.Reye syndrome
(7) Excessive use of glucose or excessive intake
1 lactation, 2 pregnancy, 3 strenuous exercise, 4 long-term fever, 5 years old and weak.
Second, after meals (reactive blood sugar)
1. Noxious hypoglycemia after gastrectomy and gastrointestinal anastomosis, or hypoglycemia after vagus nerve ablation.
2. Causes of unexplained functional hypoglycemia.
Type 3.2 Diabetes State ttiDM) early.
4. Hereditary fructose intolerance.
5. Galactoseemia.
6. Familial leucine allergic hypoglycemia.
Third, exogenous hypoglycemia
(1) Drug-induced hypoglycemia
1. Insulin and oral hypoglycemic agents, especially glybur and chlorsulfuron.
2. Other drugs 1 willowate, 2 antihistamines, 3 Ptilolol, 4 phenylbutazone, 5 monoamine oxidase inhibitor.
(two) alcoholic hypoglycemia
Fourth, other reasons
1. Central nervous system diseases associated with hypoglycemia such as thalamic brainstem lesions, brain hypoplasia, and traffic hydrocephalus.
2. Some febrile diseases associated with hypoglycemia 1 falciparum malaria, 2 epidemic hemorrhagic fever, 3 Pseudomonas aeruginosa sepsis.
Examine
an examination
Related inspection
Anti-adrenal antibody serum glucagon (PG) glycated hemoglobin component (GHb, HbA1c) serum albumin (ALB, A)
Inspection
Fasting blood glucose, blood insulin, C-peptide levels, calculation of insulin release index (fasting insulin/fasting blood glucose), hunger test if necessary (fasting hypoglycemia for 12-72 hours) and insulin release inhibition test (static) Drop R10.1U/(kg?h) and compare serum C-peptide levels before and after injection).
2. X-ray inspection
Patients with suspected insulinoma can be treated with abdominal CT, especially pancreatic CT, portal vein and splenic vein catheter for blood determination, selective pancreatic angiography.
Diagnosis
Differential diagnosis
Hypoglycemia (with or without diabetes) should be differentiated from diabetic ketoacidosis, diabetic nonketotic hyperosmolar coma, lactic acidosis coma. Severe persistent hypoglycemia is often caused by brain dysfunction, often misdiagnosed as epilepsy, schizophrenia, cerebral vasospasm, cerebrovascular accident, hemiplegia, dementia, snoring, etc., should pay attention to blood glucose monitoring.
