Hypoglycemia

In diabetic ketoacidosis, hyperosmolar nonketotic coma, and hypoglycemia, the clinical laboratory has an essential role in both diagnosis and monitoring of therapy Several analytes are frequently measured to guide clinicians in treatment regimens to restore euglycemia and correct other metabolic disturbances. The metabolic abnormalities of these conditions are beyond the scope of this book, and interested readers are referred to a standard textbook of medicine. The NACB guidelines also provide information on the tests that are used. 

The age of onset of hypoglycemia is a convenient way to classify the disorder (Box 25-5), but it should be borne in mind that some overlap occurs among the various groups. For example, some glycogen storage disorders may present in the third decade of life, and hormone deficiencies occur in childhood. 

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Generally, the untoward effects associated with tola2amide are the same as those noted with the other sulfonylureas the incidence is low and reactions are reversible when tola2amide is discontinued. Hypoglycemia has been reported occasionally. 

Metformin. Metformin [657-24-9] (1,1-dimethylbiguanide), mol wt 129.17, forms crystals from propanol, mp 218—220°C, and is soluble in water and 95% ethanol, but practically insoluble in ether and chloroform. Metformin, an investigational dmg in the United States, does not increase basal or meal-stimulated insulin secretion. It lowers blood glucose levels in hyperglycemic patients with Type II diabetes but has no effect on blood glucose levels in normal subjects. It does not cause hypoglycemia. Successful metformin therapy usually is associated with no or some weight loss. 

For many years, there has been concern by medical professionals and nutritionists over the effects of dietary sugar on human health. Sucrose has been imphcated as a cause of juvenile hyperactivity, tooth decay, diabetes meUitus, obesity, atherosclerosis, hypoglycemia, and nutrient deficiencies. 

The notion that complex carbohydrates eHcit a gradual, steady secretion of insulin while sugars cause a sudden release of this hormone accompanied by a rapid drop in blood glucose has fostered the behef that hypoglycemia is affected by sucrose ingestion. However, research does not support this conclusion (63). 

Toxic effects of propranolol are related to its blocking P-adrenoceptor blocking actions. They include cardiac failure, hypotension, hypoglycemia, and bronchospasm. Propranolol is lipophilic and crosses the blood—brain barrier. Complaints of fatigue, lethargy, mental depression, nightmares, hallucinations, and insomnia have been reported. GI side effects include nausea, vomiting, diarrhea, and constipation (1,2). 

Sulfaphenazole (684) and sulfazamet (685) are both examples of relatively short acting sulfonamides (B-80MI40406) and their antibacterial activity has been tested against Escherichia coli, the former being more effective than the latter. Sulfaphenazole also displaces sulfonyl ureas from protein binding sites on human serum albumin and consequently increases the concentration of the free (active) drug and produces a more intense reaction that may result in hypoglycemia. 

Many derivatives of 4-hydroxy-3-nitro-l,X-naphthyridin-2(lH)-ones (X = 5,6,7, and 8) were claimed to have been used for treating or preventing neuronal loss associated with stroke, ischemia, CNS trauma, hypoglycemia, and surgery as well as for treating neurodegenerative diseases, chronic pain, convulsion, anxiety, and opiate tolerance (96MI2). 

Glucose is also called blood sugar. It is absorbed readily into the bloodstream and is normally found there at concentrations ranging from 0.004 to 0.008 mol/L. If the concentration of glucose drops below 0.003 M, a condition called hypoglycemia is created, with symptoms ranging from nervousness to loss of consciousness. If the glucose level rises above 0.01 M, as can easily happen with diabetics, it is excreted in the urine. 

Class II drugs are classical (3-adrenoceptor antagonists such as propranolol, atenolol, metoprolol or the short-acting substance esmolol. These drugs reduce sinus rate, exert negative inotropic effects and slow atrioventricular conduction. Automaticity, membrane responsiveness and effective refractory period of Purkinje fibres are also reduced. The typical extracardiac side effects are due to (3-adrenoceptor blockade in other organs and include bronchospasm, hypoglycemia, increase in peripheral vascular resistance, depressions, nausea and impotence. 

Hyperactivity of the orexin system, e.g. triggered by energy depletion, metabolic failure, hypoglycemia or hypoxia, in the context of starvation, sleep derivation, and stress, may predispose to addiction and... 

Metabolic diseases In the pancreatic (3-cells, KATP channel derived from >SUR1 and Kir6.2, links cellular metabolism to electrical activity and regulates insulin secretion. Mutations in SUR1 and Kir6.2 that result in loss of Katp channel function have been identified in families with familial persistent hyperinsulinemic hypoglycemia of infancy (PHHI). 

Persistant hyperinsulinemic hypoglycemia of infancy (PHHI) SUR1 subunits of ATP-sensitive potassium channels (KATP) Sulfonylurea... 

More than half of the patients receiving this drug by the parenteral route experience some adverse reaction. Severe and sometimes life-threatening reactions include leukopenia (low white blood cell count), hypoglycemia (low blood sugar), thrombocytopenia (low platelet count), and hypotension (low blood pressure). Moderate or less severe reactions include changes in some laboratory tests, such as the serum creatinine and liver function tests. Other adverse reactions include anxiety, headache, hypotension, chills, nausea, and anorexia Aerosol administration may result in fatigue a metallic taste in the mouth, shortness of breath, and anorexia... 

Acetaminophen causes few adverse reactions when used as directed on the label or recommended by the primary health care provider. Adverse reactions associated with the use of acetaminophen usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions to acetaminophen include skin eruptions, urticaria (hives), hemolytic anemia, pancytopenia (a reduction in all cellular components of the blood), hypoglycemia, jaundice (yellow discoloration of the skin), hepatotoxicily (damage to the liver), and hepatic failure (seen in chronic alcoholics taking the drug). 

Sulfinpyrazone may increase die anticoagulant activity of oral anticoagulants. There is an increased risk of hypoglycemia when sulfinpyrazone is administered with tolbutamide. Concurrent administration of sulfinpyrazone widi verapamil may decrease die effectiveness of verapamil. 

Other causes of shock include anaphylaxis, hypoglycemia, hypothyroidism, or Addison s disease. 

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