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Hypoglycemia
Introduction
- Hypoglycemia is a decreased blood glucose concentration.
- Cause: decreased food intake or utilization; decreased glycogenolysis or gluconeogenesis; increased utilization, eg sepsis.
- Signs: weakness/collapse progressing to central nervous signs, signs associated with underlying cause.
- Diagnosis: blood glucose concentration measurement, identification of cause.
- Treatment: supportive therapy; specific therapy depending on cause.
- Prognosis: depends on cause.
Presenting signs
- Weakness.
- Collapse/seizures.
- Signs associated with the underlying cause, eg weight loss, anorexia, diarrhea, hepatic insufficiency, sepsis.
Acute presentation
- Weakness, acute collapse and/or seizures.
Geographic incidence
- Worldwide.
Age predisposition
- Adult.
- Neonate.
Pathogenesis
Etiology
- Decreased food intake or assimilation:
- Neonates.
- Starvation.
- Malabsorption.
- Maldigestion.
- Decreased production:
- Hepatic insufficiency.
- Adrenocortical insufficiency in neonates.
- Sepsis.
- Increased utilization:
- Hyperinsulinemia Pancreas: hyperinsulinemia .
- Neoplasia.
- Sepsis.
- Pregnancy.
- Hyperthermia Hyperthermia .
Predisposing factors
General- Lack of dietary intake.
- Excessive exercise.
Specific
- Hepatic disease.
- Sepsis.
- Pregnancy.
- Hyperthermia.
Pathophysiology
- Decreased production and/or increased utilization → hypoglycemia.
- Fasting → hepatic glycogenolysis maintains blood glucose until hepatic glycogen stores depleted → gluconeogenesis (hepatic and renal) utilizing body proteins and glycerol.
- Insulin → inhibition of gluconeogenesis and uptake of glucose into cells → reduces blood glucose.
- Hypoglycemia → glucagon increases, insulin decreases → glycogenolysis and/or gluconeogenesis → increased blood glucose.
Timecourse
- Acute or chronic, depending on cause.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Wong D et al (2015) Hypoglycaemia associated with cholangiocarcinoma and peritoneal carcinomatosis in a horse. Vet radiol Ultrasound 56 (1), E9-E12 PubMed.
- Lyle C H et al (2010) Retrospective evaluation of episodic collapse in the horse in a referred population: 25 cases (1995-2009). J Vet Intern Med 24 (6), 1498-1592 PubMed.
- Hollis A R et al (2008) Blood glucose concentrations in critically ill neonatal foals. J Vet Intern Med 22 (5), 1223-1227 PubMed.
- Alexander S L, Roud H K & Irvine C H (1997) Effect of insulin-induced hypoglycemia on secretion patterns and rate of corticotropin-releasing hormone, arginine vasopressin and adrenocorticotropin in horses. J Endocrinol 153 (3), 401-409 PubMed.