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However, the diagnosis of ketotic hypoglycemia poses a challenge to clinicians, given how nonspecific symptoms can be and given that children in this age range are typically unable to describe their symptoms. [2] Thin or smaller children may be more prone to episodes of ketotic hypoglycemia due to reduced fasting tolerance and minimal fat ...
People with type 1 diabetes mellitus who must take insulin in full replacement doses are most vulnerable to episodes of hypoglycemia (low blood glucose levels). This can occur if a person takes too much insulin or diabetic medication, does strenuous exercise without eating additional food, misses meals, consumes too much alcohol, or consumes alcohol without food. [5]
During the 48-hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may trigger transient hypoglycemia. [8] In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9–5.5 mmol/L), similar to adults, with hypoglycemia being far less common. [8]
Adolf Kussmaul referred to breathing when metabolic acidosis was sufficiently severe for the respiratory rate to be normal or reduced. [2] This definition is also followed by several other sources, [3] [4] including for instance Merriam-Webster, which defines Kussmaul breathing as "abnormally slow deep respiration characteristic of air hunger and occurring especially in acidotic states". [5]
This can reduce glucose availability and lead to hypoglycemia and increased reliance on fatty acid and ketone metabolism. [1] [5] An additional stressor such as vomiting or dehydration can cause an increase in counterregulatory hormones such as glucagon, cortisol and growth hormone which may further increase free fatty acid release and ketone ...
[1] [2] Breath may also develop the smell of acetone as it is a volatile ketone that can be exhaled. Rapid deep breathing, or Kussmaul breathing, may be present to compensate for the metabolic acidosis. [1] Altered mental status is more common in diabetic than alcoholic ketoacidosis. [2]
Not all of the above manifestations occur in every case of hypoglycemia. There is no consistent order to the appearance of the symptoms. Specific manifestations vary by age and by the severity of the hypoglycemia. In older children and adults, moderately severe hypoglycemia can resemble mania, mental illness, drug intoxication, or drunkenness.
Whipple's triad is a collection of three signs (called Whipple's criteria) that suggests that a patient's symptoms result from hypoglycaemia that may indicate insulinoma.The essential conditions are symptoms of hypoglycaemia, low blood plasma glucose concentration, and relief of symptoms when plasma glucose concentration is increased.