HIPOGLUCEMIA

DR RUBEN ALBERTO VILLALOBOS MENDEZ

R1-URGENCIAS MEDICO-QUIRURGICAS
HOSPITAL REGIONAL DE PEMEX

Introduccin

En 90% de los
diabticos
nsulinodependien
tes

35% - episodio de
hipoglucemia
grave

Hipoglucemia
asintomtica

2 a 4% muertes
hipoglucemia

> 75 aos de
edad.

Manual de Medicina de Urgenciass. Dr Alejandro Villatoro Mertinez, ed

Definicin

Sntomas
Neruroglucopenic
os y
Adrenocolinergico
s
Glucosa
Hombre < 60
mg/dl
Mujeres <50
mg/dl

Desaparicin de
sntomas con
glucosa

Tratado de Medicina de Urgencias. Manuel S.Maya/Pascual

Piera/Miguel Marine. Ed 2011

Triada de Whipple:

Glucemia
baja

Sntomas de
hipoglucemi
a
Mejora de la
sintomatolog
a al ingerir
glucosa
Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F John Service, MD, PhD Philip E Cryer, MD
Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our
peer review process is complete. Literature review current through: Feb 2015. | This topic last updated: Apr 26, 2013

Etiologa

Fisiopatologa

Glucosa

Sustrato
energtico
del sistema
nervioso
central

1 a 1.2
mg/kg/min

Respuesta fisiolgica a la hipoglucemia en sujetos normales y pacientes con diabetes mellitus Autor Philip E Cryer,
MD Editor de la Seccin David M Nathan, MD Adjunto Editor Jean E Mulder, MD Todos los temas se actualizan a medida que se
disponga de nuevas pruebas y nuestro proceso de revisin se ha completado. Actual revisin de la literatura a travs de: . 03
2015 | En este tema se actualiz por ltima vez: 31 de julio2014.

Daa los
tejidos
Altera la
funcin

Muerte
por
deficienci
a
prolongad
a

Respuesta fisiolgica a la hipoglucemia en sujetos normales y pacientes con diabetes mellitus Autor Philip E Cryer,
MD Editor de la Seccin David M Nathan, MD Adjunto Editor Jean E Mulder, MD Todos los temas se actualizan a medida que se
disponga de nuevas pruebas y nuestro proceso de revisin se ha completado. Actual revisin de la literatura a travs de: . 03
2015 | En este tema se actualiz por ltima vez: 31 de julio2014.

Glucosa en sangre normal de

120 mg/dL

60 a

Hipoglucemia de 40 y 50 mg/100 mL
En neonatos de 30 mg/100 mL
En prematuros de 20 mg/100 mL.
Respuesta fisiolgica a la hipoglucemia en sujetos normales y pacientes con diabetes mellitus Autor Philip E Cryer,
MD Editor de la Seccin David M Nathan, MD Adjunto Editor Jean E Mulder, MD Todos los temas se actualizan a medida que se
disponga de nuevas pruebas y nuestro proceso de revisin se ha completado. Actual revisin de la literatura a travs de: . 03
2015 | En este tema se actualiz por ltima vez: 31 de julio2014.

Fisiopatologa

Principios de Medicina Interna. Harrison Ed 2012

Fisiopatologa

Principios de Medicina Interna. Harrison Ed 2012

Fenmeno de Somogyi

Dosis
excesiva de
insulina

Hipoglucemi
a no
reconocida

Hiperglucem
ia de rebote

Tratado de Medicina de Urgencias. Manuel S.Maya/Pascual

Piera/Miguel Marine. Ed 2011

Diagnostico

Historia

En diabticos

No diabticos

Buscar
antecedentes
familiares,
personales, o ambos
de diabetes o
alcoholismo,

Antecedentes
Antecedentes
farmacolgicos

Historia diettica
detallada

Insuficiencia renal,
heptica o
suprarrenal y
embarazo

Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F John Service, MD, PhD Philip E Cryer, MD
Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our
peer review process is complete. Literature review current through: Feb 2015. | This topic last updated: Apr 26, 2013.

Sntomas y exploracin fsica

Sntomas adrenrgicos

Inician con adrenalina en cifras sricas de 69 +

2mg/dL,
Noradrenalina 51 + 3 mg/dL,
Glucagn 68 + 2 mg/dL
Cortisol 58 + 3 mg/dL
Hormona del crecimiento 66 + 2 mg/dL,

Glucemia de 53 + 3mg/dL,
Diabticos glucemia de 78 mg/dL

Glucemia < 36 mg/100 mL

Sntomas por neuroglucopenia

Glucemia < 36 mg/100 mL

Insuficiencia cardiaca

Congestin heptica

Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F John Service, MD, PhD Philip E Cryer, MD
Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our
peer review process is complete. Literature review current through: Feb 2015. | This topic last updated: Apr 26, 2013.

Signos neurolgicos

Cortical
Somnolencia

Subcortical
Chupeteo
Muecas

espasmos clnicos

Mesencfalo
Desviacin
Bakinsky

ocular

Signos neurolgicos

Promecencefalo
Espasmo

intenso reaccin cruzada

Mielencefalo
Coma

respiratorio central
Bradicardia
Miosis, hiporreflexia
Hipotermia

Parocardiorespiratorio

Clasificacin clnica

Hipoglucemia severa:
Hipoglucemia sintomtica
documentada
Hipoglucemia asintomtica
Hipoglucemia sintomtica
probable:
Pseudohipoglucemia:

No se documenta hipoglucemia
Glucosa < 70 mg/dl + sntomas
Glucosa < 70 mg/dl, asintomtico
Sntomas sin glucosa < 70 mg/dl
Sntomas con glucosa > 70 mg/dl

Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F John Service, MD, PhD Philip E Cryer, MD
Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our
peer review process is complete. Literature review current through: Feb 2015. | This topic last updated: Apr 26, 2013.

Estudios de laboratorio
Glucosa

Alcohol

Insulina

Cortisol

Pptido de
conexin de
la insulina
(pptido C)
Toxinas y
frmacos
(sulfonilurea
s)

Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F John Service, MD, PhD Philip E Cryer, MD
Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our
peer review process is complete. Literature review current through: Feb 2015. | This topic last updated: Apr 26, 2013.

Tratamiento

Primera lnea
25 a 50 mL de
dextrosa al 50%
en 3 a 5 min IV.

Dextros
a
Repetir dosis a
los 10 a 20 min

En nios 2 a 4 mL/kg de
dextrosa al 25%.

Iniciar
infusin de
glucosa al
10%.

Management of hypoglycemia during treatment of diabetes mellitus Author Philip E Cryer, MD Section Editor Irl B
Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our peer review
process is complete. Literature review current through: Feb 2015. | This topic last updated: May 15, 2014.

Segunda lnea
Glucagn.
(DM) tipo 1)

Alcohlicos

Desnutrido
s

100 mg de
Tiamina IV

1 mg SC en
adultos en
general

La dosis es
de 0.5 mg en
nios

Management of hypoglycemia during treatment of diabetes mellitus Author Philip E Cryer, MD Section Editor Irl B
Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our peer review
process is complete. Literature review current through: Feb 2015. | This topic last updated: May 15, 2014.

Tercera lnea
Diazoxid
o
octreotid
o

300 a 1 200
mg/dia
IV o VO

100 a 600
g/dia
Sc

Management of hypoglycemia during treatment of diabetes mellitus Author Philip E Cryer, MD Section Editor Irl B
Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are updated as new evidence becomes available and our peer review
process is complete. Literature review current through: Feb 2015. | This topic last updated: May 15, 2014.

CRITERIOS DE INTERNAMIENTO

Neuroglucopenia
Hipoglucemiantes
orales

No resolucin
rpida

df

Fiebre
Medicina de Urgencias, Judith E. Tintinalli Ed 2013

Gracia
s

Bibliografia

Hypoglycemia in adults: Clinical manifestations, definition, and causesAuthors F

John Service, MD, PhD Philip E Cryer, MD Section Editor Irl B Hirsch, MD Deputy Editor Jean E
Mulder, MD All topics are updated as new evidence becomes available and our peer review
process is complete. Literature review current through: Feb 2015. | This topic last updated:
Apr 26, 2013.

Hypoglycemia in adults without diabetes mellitus: Diagnostic approach Author F

John Service, MD, PhD Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All
topics are updated as new evidence becomes available and our peer review process is
complete. Literature review current through: Feb 2015. | This topic last updated: Mar 17,
2014.

Management of hypoglycemia during treatment of diabetes mellitus Author Philip E

Cryer, MD Section Editor Irl B Hirsch, MD Deputy Editor Jean E Mulder, MD All topics are
updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Feb 2015. | This topic last updated: May 15, 2014.

Standards of Medical Care in Diabetes2014. Diabetes Care. 2014;376(Supplement 1):S5S13

Manual de Medicina de Urgenciass. Dr Alejandro Villatoro Mertinez, ed 2011

Respuesta fisiolgica a la hipoglucemia en sujetos normales y pacientes con diabetes mellitus Autor Philip E Cryer,
MD Editor de la Seccin David M Nathan, MD Adjunto Editor Jean E Mulder, MD Todos los temas se actualizan a medida que se
disponga de nuevas pruebas y nuestro proceso de revisin se ha completado. Actual revisin de la literatura a travs de: . 03