Hypoglycemia, transient

O Determining a correct and accurate diagnosis is essential prior to any consideration of pharmacotherapy. When a patient complains of paroxysmal, stereotypical spells that may be seizures, it must be determined if the spells are really seizures. Numerous other disorders, including syncope, psychogenic nonepileptic events (i.e., pseudoseizures), anxiety attacks, cardiac arrhythmias, hypoglycemia, transient ischemic... 

There are currently no diagnostic laboratory tests for epilepsy. In some cases, particularly following GTC (or perhaps CP) seizures, serum prolactin levels may be transiently elevated. Laboratory tests may be done to rule out treatable causes of seizures (e.g., hypoglycemia, altered serum electrolyte concentrations, infections, etc.) that do not represent epilepsy. 

A comparable placebo-controlled study was reported in 353 patients with type 2 diabetes for 48 weeks. All were taking insulin, and HbAlc fell in those who also took metformin. Body weight was reduced by 0.4 kg by metformin and increased by 1.2 kg by placebo. Symptomatic episodes of hypoglycemia were more common with metformin. There were mild transient gastrointestinal complaints in 56 and 13% respectively (27). 

Neurological symptoms are common and hypoglycemia can cause hemiplegia, which can be confused with neurological symptoms of other origin (transient ischemic attack, stroke, etc.). A bilateral case has been reported (40). 

Wattoo MA, Liu HH. Alternating transient dense hemiplegia due to episodes of hypoglycemia. West J Med 1999 170(3) 170-1. 

Interleukin-1-beta has been associated with transient hypoglycemia (566). 

High systemic doses of lidocaine can cause transient hypoglycemia (SED-12, 255) (598). 

Subsequent studies have shown (e.g. 5,6, Table I) that the liver of newborns is indeed deficient in enzymes needed not only for drug metabolism but also for the elimination of natural products. For example, because of the lack of UDP-glucuronyl transferase resulting in the inability to dispose of bilirubin, the newborn is at risk for brain damage by kernicterus. That PEP carboxykinase, the key catalyst of gluconeogenesis de novo is absent at 7 months and still at low titers 3 days after birth (Table I), probably contributes to the fact that transient hypoglycemia (which can also cause brain damage) represents a hazard to full term as well as premature infants. The immaturity of the hepatic enzyme composition imposes limitations on the choice of nutrients used to supplement or re-... 

Hasegawa Y, Formato JE, Latour LL, Gutierrez JA, Liu KF, Garcia JH, Sotak CH, Fisher M (1996) Severe transient hypoglycemia causes reversible change in the apparent diffusion coefficient of water. Stroke 27 1648-1655 discussion 1655-1646... 

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