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Quizlet Which Baby Should the Nurse Know Is at Risk for Hypoglycemia

Written By Monday, January 17, 2022 Add Comment Edit

Not enough blood sugar, usually because of temporary overcorrection of diabetes

Not to be confused with the opposite disorder, hyperglycemia.

Medical condition

Hypoglycemia
Other names Hypoglycaemia, hypoglycæmia, low blood glucose, low blood sugar
Glucose test.JPG
Glucose meter
Specialty Endocrinology
Symptoms Headache, blurred vision, shakiness, dizziness, weakness, tiredness, sweating, clamminess, fast heart rate, pounding heartbeat, nervousness or anxiety, hunger, nausea, pins and needles sensation, difficulty talking, confusion, loss of consciousness, unusual behavior, lightheadedness, pale skin color, seizures, death[1] [2] [3] [4] [5]
Usual onset Rapid[1]
Causes Medications (insulin and sulfonylureas), sepsis, kidney failure, certain tumors, liver disease[1] [6] [7]
Diagnostic method Blood sugar level < 3.9 mmol/L (70 mg/dL) in a diabetic[1]
Treatment Eating foods high in simple sugars, dextrose, glucagon[1]

Hypoglycemia, also known as low blood sugar, is a fall in blood sugar to levels below normal.[1] This may result in a variety of symptoms, including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death.[1] Feelings of hunger, sweating, shakiness, or weakness may also be present.[1] Symptoms typically come on quickly.[1]

The most common cause of hypoglycemia is medications used to treat diabetes such as insulin and sulfonylureas.[6] [7] Risk is greater in diabetics who have eaten less than usual, recently exercised,[8] or drunk alcohol.[1] Other causes of hypoglycemia include kidney failure, certain tumors (such as insulinoma), liver disease, hypothyroidism, starvation, inborn error of metabolism, severe infections, reactive hypoglycemia, and a number of drugs, including alcohol.[1] [7] Low blood sugar may occur in otherwise healthy babies who have not eaten for a few hours.[9]

The glucose level that defines hypoglycemia is variable.[1] In people with diabetes, levels below 3.9 mmol/l (70 mg/dl) are diagnostic.[1] In adults without diabetes, symptoms related to low blood sugar, low blood sugar at the time of symptoms, and improvement when blood sugar is restored to normal confirm the diagnosis.[2] Otherwise, a level below 2.8 mmol/l (50 mg/dl) after not eating or following exercise may be used.[1] In newborns, a level below 2.2 mmol/l (40 mg/dl), or less than 3.3 mmol/l (60 mg/dl) if symptoms are present, indicates hypoglycemia.[9] Other tests that may be useful in determining the cause include insulin and C peptide levels in the blood.[7]

Among people with diabetes, prevention is by matching the foods eaten with the amount of exercise and the medications used.[1] When people feel their blood sugar is low, testing with a glucose monitor is recommended.[1] Some people have few initial symptoms of low blood sugar, and frequent routine testing in this group is recommended.[1] Treatment of hypoglycemia is by eating foods high in simple sugars or taking dextrose.[1] If a person is not able to take food by mouth, glucagon by injection or in the nose may help.[1] [10] The treatment of hypoglycemia unrelated to diabetes includes treating the underlying problem and a healthy diet.[1] The term "hypoglycemia" is sometimes incorrectly used to refer to idiopathic postprandial syndrome, a controversial condition with similar symptoms that occurs following eating, but with normal blood sugar levels.[11] [12]

Definition [edit]

Blood sugar levels naturally fluctuate throughout the day, however hypoglycemia, also called low blood sugar or low blood glucose, is when blood sugar levels drop below 70 mg/dL (3.9 mmol/L).[3] [5] Please note that people may have different blood sugar target levels based on their glucose meters or health conditions, and as a result it is important to consult a doctor on personalized blood sugar target levels.[5]

Whipple's triad [edit]

The symptoms of low blood sugar alone are not specific enough to characterize a hypoglycemic episode.[2] A single blood sugar reading below 70 mg/dL is also not specific enough characterize a hypoglycemic episode.[2] Whipple's triad is a set of three conditions that need to be met in order to accurately characterize a hypoglycemic episode.[2]

The three conditions are the following:

  1. The signs and symptoms of hypoglycemia are present (see section below on Signs and Symptoms)[2]
  2. A low blood glucose measurement is present, typically less than 70 mg/dL (3.9 mmol/L)[2]
  3. The signs and symptoms of hypoglycemia resolve after blood glucose levels have returned to normal[2]

Differential diagnosis [edit]

Other conditions that may present similarly to hypoglycemia include the following:

  • Alcohol or drug intoxication[2] [13] [14]
  • Cardiac arrhythmia[2] [14]
  • Valvular heart disease[2] [14]
  • Postprandial syndrome[14]
  • Hyperthyroidism[14]
  • Pheochromocytoma[14]
  • Post-gastric bypass hypoglycemia[2] [14]
  • Generalized anxiety disorder[14]
  • Surreptitious insulin use[2] [14]
  • Lab or blood draw error (lack of antiglycolytic agent in collection tube or during processing)[14]

Signs and symptoms [edit]

Hypoglycemic symptoms are divided into two main categories, with the first category being symptoms caused by low glucose in the brain, called neuroglycopenic symptoms.[3] The second category of symptoms is caused by the body's reaction to low glucose in the brain, called adrenergic symptoms.[3]

Neuroglycopenic symptoms Adrenergic symptoms
  • Headache
  • Blurred vision
  • Tiredness (also called Fatigue)
  • Unusual behavior
  • Confusion
  • Lightheadedness
  • Difficulty speaking or slurred speech
  • Seizures
  • Loss of consciousness (sometimes called passing out)
  • Death, if severe hypoglycemia
  • Fast heart rate
  • Pounding heartbeat (also called Palpitations)
  • Sweating
  • Clamminess
  • Shakiness or tremulousness
  • Nervousness (also called Anxiety)
  • Hunger
  • Nausea
  • Pins and needles sensation
  • Pale skin color
References:[1] [2] [3] [4] [5]

Everyone experiences different symptoms of hypoglycemia, so someone with hypoglycemia may not show all of the symptoms listed above.[3] [4] [5] Symptoms also tend to have quick onset.[5] It is important to quickly obtain a blood glucose measurement in someone presenting with symptoms of hypoglycemia in order to properly identify the hypoglycemic episode.[2] [5]

Causes [edit]

The most common cause of hypoglycemia is medications used to treat diabetes mellitus such as insulin, sulfonylureas, and biguanides.[6] [7] Risk is greater in diabetics who have eaten less than usual, exercised more than usual, or drunk alcohol.[1] Other causes of hypoglycemia include kidney failure, certain tumors, liver disease, hypothyroidism, starvation, inborn errors of metabolism, severe infection or sepsis, reactive hypoglycemia, and a number of drugs, including alcohol.[1] [7] Low blood sugar may occur in babies who are otherwise healthy who have not eaten for a few hours.[9] Inborn errors of metabolism may include the lack of an enzyme to make glycogen (glycogen storage type 0).

Serious illness [edit]

Serious illness may result in low blood sugar.[1] Severe disease of nearly all major organ systems can cause hypoglycemia as a secondary problem. Hospitalized persons, especially in intensive care units or those prevented from eating, can develop hypoglycemia from a variety of circumstances related to the care of their primary disease. Hypoglycemia in these circumstances is often multifactorial or caused by the healthcare. Once identified, these types of hypoglycemia are readily reversed and prevented, and the underlying disease becomes the primary problem.

Hormone deficiency [edit]

Not enough cortisol, such as in Addison's disease, not enough glucagon, or not enough epinephrine can result in low blood sugar.[1] This is a more common cause in children.[1]

Pathophysiology [edit]

The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal, and metabolic responses to a falling glucose level. Most of these are defensive or adaptive, tending to raise the blood sugar by glycogenolysis and gluconeogenesis or provide alternative fuels. If the blood sugar level falls too low, the liver converts a storage of glycogen into glucose and releases it into the bloodstream, to prevent the person going into a diabetic coma, for a short time.

Brief or mild hypoglycemia produces no lasting effects on the brain, though it can temporarily alter brain responses to additional hypoglycemia. Prolonged, severe hypoglycemia can produce lasting damage of a wide range. This can include impairment of cognitive function, motor control, or even consciousness. The likelihood of permanent brain damage from any given instance of severe hypoglycemia is difficult to estimate and depends on a multitude of factors such as age, recent blood and brain glucose experience, concurrent problems such as hypoxia, and availability of alternative fuels. Prior hypoglycemia also blunts the counter-regulatory response to future hypoglycemia.[15] While the mechanism leading to blunted counterregulation is unknown several have been proposed.[16]

Those type 1 diabetics found "dead in bed" in the morning after suspected severe hypoglycemia are often found to have had some underlying coronary pathology that led to an induced fatal heart attack.[17] In 2010, a case report was published demonstrating the first known case of an individual found "dead in bed" whilst wearing a continuous glucose monitor, which provided a history of glucose levels before the fatal event; the person had suffered a severe hypoglycemic incident, and while the authors described only a "minimal counter-regulatory response", they stated no "anatomic abnormalities" were observed during autopsy.[18]

The vast majority of symptomatic hypoglycemic episodes results in no detectable permanent harm.[19]

Diagnosis [edit]

The glucose level that defines hypoglycemia is variable. In diabetics a level below 3.9 mmol/l (70 mg/dl) is diagnostic.[1] In adults without diabetes, symptoms related to low blood sugar, low blood sugar at the time of symptoms, and improvement when blood sugar is restored to normal confirm the diagnosis.[2] This is known as the Whipple's triad.[2] Otherwise, a level below 2.8 mmol/l (50 mg/dl) after not eating or following exercise may be used.[1] In newborns, a level below 2.2 mmol/l (40 mg/dl) or less than 3.3 mmol/l (60 mg/dl) if symptoms are present indicates hypoglycemia.[9] Other tests that may be useful in determining the cause include insulin and C peptide levels in the blood.[7] Hyperglycemia, a high blood sugar level, is the opposite condition.

Throughout a 24‑hour period, blood plasma glucose levels are generally maintained between 4 and 8 mmol/l (72 and 144 mg/dl).[20] : 11 Although 3.3 or 3.9 mmol/l (60 or 70 mg/dl) is commonly cited as the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until 2.8 to 3.0 mmol/l (50 to 54 mg/dl).[21]

In cases of recurrent hypoglycemia with severe symptoms, the best method of excluding dangerous conditions is often a diagnostic fast. This is usually conducted in the hospital, and the duration depends on the age of the person and response to the fast. A healthy adult can usually maintain a glucose level above 2.8 mmol/l (50 mg/dl) for 72 hours, a child for 36 hours, and an infant for 24 hours. The purpose of the fast is to determine whether the person can maintain his or her blood glucose as long as normal, and can respond to fasting with the appropriate metabolic changes. At the end of the fast, insulin should be nearly undetectable and ketosis should be fully established. The person's blood glucose levels are monitored and a critical specimen is obtained if the glucose falls. Despite its unpleasantness and expense, a diagnostic fast may be the only effective way to confirm or refute a number of serious forms of hypoglycemia, especially those involving excessive insulin.

The precise level of glucose considered low enough to define hypoglycemia is dependent on the measurement method, the age of the person, presence or absence of effects, and the purpose of the definition. While no disagreement exists as to the normal range of blood sugar, debate continues as to what degree of hypoglycemia warrants medical evaluation or treatment, or can cause harm.[22] [23] [24]

Deciding whether a blood glucose in the borderline range of 2.5–4.2 mmol/l (45–75 mg/dl) represents clinically problematic hypoglycemia is not always simple. This leads people to use different "cutoff levels" of glucose in different contexts and for different purposes. Because of all the variations, the Endocrine Society recommends that a diagnosis of hypoglycemia as a problem for an individual be based on the combination of a low glucose level and evidence of adverse effects.[2]

Glucose concentrations are expressed as millimoles per litre (mmol/l or mM) in most of the world, and milligrams per deciliter (mg/dl or mg/100 ml) in Lebanon, the United States, Japan, Portugal, Spain, France, Belgium, Egypt, Turkey, Saudi Arabia, Colombia, India, and Israel.[ citation needed ] Glucose concentrations expressed as mg/dl can be converted to mmol/l by dividing by 18.0 g/dmol (the molar mass of glucose). For example, a glucose concentration of 90 mg/dl is 5.0 mmol/l or 5.0 mM.

Method of measurement [edit]

Blood glucose levels discussed in this article are venous plasma or serum levels measured by standard, automated glucose oxidase methods used in medical laboratories. For clinical purposes, plasma and serum levels are similar enough to be interchangeable. Arterial plasma or serum levels are slightly higher than venous levels, and capillary levels are typically in between.[25] This difference between arterial and venous levels is small in the fasting state, but is amplified and can be greater than 10% in the postprandial state. Whole blood glucose levels (e.g., by fingerprick glucose meters), though, are about 10–15% lower than venous plasma levels.[25] Furthermore, available fingerstick glucose meters are only warranted to be accurate to within 15% of a simultaneous laboratory value under optimal conditions,[ citation needed ] and home use in the investigation of hypoglycemia is fraught with misleadingly low numbers.[27] [28] In other words, a meter glucose reading of 39 mg/dl could be properly obtained from a person whose laboratory serum glucose was 53 mg/dl; even wider variations can occur with "real world" home use.

Two other factors significantly affect glucose measurement: hematocrit and delay after blood drawing. The disparity between venous and whole blood concentrations is greater when the hematocrit is high, as in newborn infants, or adults with polycythemia. High neonatal hematocrits are particularly likely to confound glucose measurement by meter. Second, unless the specimen is drawn into a fluoride tube or processed immediately to separate the serum or plasma from the cells, the measurable glucose will be gradually lowered by in vitro metabolism of the glucose at a rate around 7 mg/dl/h, or even more in the presence of leukocytosis.[29] [30] The delay that occurs when blood is drawn at a satellite site and transported to a central laboratory hours later for routine processing is a common cause of mildly low glucose levels in general chemistry panels.

Age [edit]

Children's blood sugar levels are often slightly lower than adults'. Overnight fasting glucose levels are below 3.9 mmol/l (70 mg/dl) in 5% of healthy adults, but up to 5% of children can be below 3.3 mmol/l (60 mg/dl) in the morning fasting state.[31] As the duration of fasting is extended, a higher percentage of infants and children will have mildly low plasma glucose levels, typically without symptoms. The normal range of newborn blood sugars continues to be debated.[22] [23] [24] Newborns' brains are thought to be able to use alternative fuels when glucose levels are low more readily than adults. Experts continue to debate the significance and risk of such levels, though the trend has been to recommend maintenance of glucose levels above 60–70 mg/dl the first day after birth.

Diabetic hypoglycemia represents a special case with respect to the relationship of measured glucose and hypoglycemic symptoms for several reasons. First, although home glucose meter readings are often misleading, the probability that a low reading, whether accompanied by symptoms or not, represents real hypoglycemia is much higher in a person who takes insulin than in someone who does not.[32] [33]

Other tests [edit]

The following is a brief list of hormones and metabolites that may be measured in a critical sample. Not all tests are checked on every person. A "basic version" would include insulin, cortisol, and electrolytes, with C-peptide and drug screen for adults and growth hormone in children. The value of additional specific tests depends on the most likely diagnoses for an individual person, based on the circumstances described above. Many of these levels change within minutes, especially if glucose is given, and there no value exists in measuring them after the hypoglycemia is reversed. Others, especially those lower in the list, remain abnormal even after hypoglycemia is reversed, and can be usefully measured even if a critical specimen is missed.

Part of the value of the critical sample may simply be the proof that the symptoms are indeed due to hypoglycemia. More often, measurement of certain hormones and metabolites at the time of hypoglycemia indicates which organs and body systems are responding appropriately and which are functioning abnormally. For example, when the blood glucose is low, hormones that raise the glucose level should be rising and insulin secretion should be completely suppressed.

Prevention [edit]

The most effective methods of preventing further episodes of hypoglycemia depend on the cause.

The risk of further episodes of diabetic hypoglycemia can often be reduced by lowering the dose of insulin or other medications, or by more meticulous attention to blood-sugar balance during unusual hours, higher levels of exercise, or decreasing alcohol intake. A preservation of endogenous insulin levels above 0,12nmol/l in persons with type 1 diabetes has also proven to decrease the amount and severity of hypoglycemic events.[34] Many of the inborn errors of metabolism require avoidance or shortening of fasting intervals, or extra carbohydrates. For the more severe disorders, such as type 1 glycogen storage disease, this may be supplied in the form of cornstarch every few hours or by continuous gastric infusion.

Several treatments are used for hyperinsulinemic hypoglycemia, depending on the exact form and severity. Some forms of congenital hyperinsulinism respond to diazoxide or octreotide. Surgical removal of the overactive part of the pancreas is curative with minimal risk when hyperinsulinism is focal or due to a benign insulin-producing tumor of the pancreas. When congenital hyperinsulinism is diffuse and refractory to medications, near-total pancreatectomy may be the treatment of last resort, but is less consistently effective and fraught with more complications.

Hypoglycemia due to hormone deficiencies such as hypopituitarism or adrenal insufficiency usually ceases when the appropriate hormone is replaced.

Hypoglycemia due to dumping syndrome and other postsurgical conditions is best dealt with by altering diet. Including fat and protein with carbohydrates may slow digestion and reduce early insulin secretion. Some forms of this respond to treatment with an alpha-glucosidase inhibitor, which slows starch digestion.

Reactive hypoglycemia with demonstrably low blood-glucose levels is most often a predictable nuisance that can be avoided by consuming fat and protein with carbohydrates, by adding morning or afternoon snacks, and reducing alcohol intake.

Idiopathic postprandial syndrome without demonstrably low glucose levels at the time of symptoms can be more of a management challenge. Many people find improvement by changing eating patterns (smaller meals, avoiding excessive sugar, mixed meals rather than carbohydrates by themselves), reducing intake of stimulants such as caffeine, or by making lifestyle changes to reduce stress.

Treatment [edit]

After hypoglycemia in a person is identified, rapid treatment is necessary and can be life-saving.[1] The main goal of treatment is to raise blood glucose back to normal levels, which is done through various ways of administering glucose, depending on the severity of the hypoglycemia, what is on-hand to treat, and who is administering the treatment.[1] [3] A general rule used by the American Diabetes Association is the "15-15 Rule," which suggests consuming or administering 15 grams of a carbohydrate, followed by a 15-minute wait and re-measurement of blood glucose level to assess if blood glucose has returned to normal levels or is still low, requiring repeated treatment.[5] [35]

Self-treatment [edit]

If an individual recognizes the symptoms of hypoglycemia coming on, blood sugar should promptly be obtained, and a sugary food or drink should be consumed.[1] The person must be conscious and able to swallow.[1] [3] The goal is to consume 10-20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L).[2] [3]

Examples of things to consume are:

  • Glucose tabs or gel (refer to instructions on packet)[1] [2]
  • Juice containing sugar like apple, grape, or cranberry juice, 4 ounces or 1/2 cup[1] [2]
  • Soda or a soft-drink, 4 ounces or 1/2 cup (however NOT diet soda)[2]
  • Candy[2]
  • Table sugar or honey, 1 tablespoon[1]

Improvement in blood sugar levels and symptoms are expected to occur in 15–20 minutes, at which point blood sugar should be measured again.[2] [3] [35] If the repeat blood sugar level is not above 70 mg/dL (3.9 mmol/L), consume another 10-20 grams of a carbohydrate and remeasure blood sugar levels after 15–20 minutes.[2] [3] [35] Repeat until blood glucose levels have returned to normal levels.[2] [3] The greatest improvements in blood glucose will be seen if the carbohydrate chewed or drunk, and then swallowed.[36] This results in the greatest bioavaliablity of glucose, meaning the greatest amount of glucose enters the body producing the best possible improvements in blood glucose levels.[36] The second best way to consume a carbohydrate it to allow it to dissolve under the tongue, also referred to as sublingual administration. [36] For example, a hard candy can be dissolved under the tongue, however the best improvements in blood glucose will occur if the hard candy is chewed and crushed, then swallowed.[36]

After correcting blood glucose levels, consume a full meal within one hour in order to replenish glucagon stores within the body.[2]

Emergency treatment by general public [edit]

Upon recognizing the signs and symptoms of hypoglycemia in an individual, quickly obtain a blood sugar level using a glucose meter.[1] If blood glucose is below 70 mg/dL (3.9 mmol/L), treatment will depend on whether the person is conscious and can swallow safely.[2] [3]

Hypoglycemic individial is conscious [edit]

If the person is conscious and able to swallow, refer to subsection directly above on Self-treatment. Assist the person in eating or drinking 10-20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L).[2] Improvement in blood sugar levels and symptoms are expected to occur in 15–20 minutes, at which point blood sugar should be measured again.[2] [3] [35] If the repeat blood sugar level is not above 70 mg/dL (3.9 mmol/L), help the person consume another 10-20 grams of a carbohydrate and remeasure blood sugar levels after 15–20 minutes.[2] [3] [35] Repeat until blood glucose levels have returned to normal levels.[2]

Hypoglycemic individial is unconscious [edit]

(Section under construction)

If the person is unconscious or unable to swallow, obtain a glucacon kit to administer glucacon in the form of an injection into a large muscle or an intra-nasal powder.[1] [2]

Education [edit]

It is important to tell family, friends, and co-workers of a diabetes diagnosis, as they can provide life-saving treatment in the case of a hypoglycemic episode.[1] It is key to inform these people of usual signs and symptoms of a hypoglycemic episode, as well as provide training with how to administer injectable or intra-nasal glucacon, and inform these individuals where they can find the glucagon kit and a glucose meter.[1] Ensure that all glucacon kits are easy to find and regularly replaced to avoid expiration.[1]

Treatment by medical professionals [edit]

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If a person has such severe effects of hypoglycemia that they cannot (due to combativeness) or should not (due to seizures or unconsciousness) be given anything by mouth, medical personnel such as paramedics, or in-hospital personnel can give intravenous dextrose, concentrations varying depending on age (infants are given 2 ml/kg dextrose 10%, children are given dextrose 25%, and adults are given dextrose 50%). Care must be taken in giving these solutions because they can cause skin necrosis if the IV is infiltrated, sclerosis of veins, and many other fluid and electrolyte disturbances if administered incorrectly. If IV access cannot be established, the person can be given 1 to 2 mg of glucagon in an intramuscular injection. If a person has less severe effects, and is conscious with the ability to swallow, medical personal may administer gelatinous oral glucose.

Other treatments [edit]

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The soft drink Lucozade has been used for hypoglycemia in the United Kingdom, but it has recently replaced much of its glucose with artificial sweeteners, which do not treat hypoglycemia.[37]

Dasiglucagon was approved for medical use in the United States in March 2021, to treat severe hypoglycemia.[38]

Patient Education [edit]

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History [edit]

Hypoglycemia was first discovered by James Collip when he was working with Frederick Banting on purifying insulin in 1922. Collip was asked to develop an assay to measure the activity of insulin. He first injected insulin into a rabbit, and then measured the reduction in blood-glucose levels. Measuring blood glucose was a time-consuming step. Collip observed that if he injected rabbits with a too large a dose of insulin, the rabbits began convulsing, went into a coma, and then died. This observation simplified his assay. He defined one unit of insulin as the amount necessary to induce this convulsing hypoglycemic reaction in a rabbit. Collip later found he could save money, and rabbits, by injecting them with glucose once they were convulsing.[39]

Etymology [edit]

The word hypoglycemia is also spelled hypoglycaemia or hypoglycæmia. The term means 'low blood sugar' from Greek ὑπογλυκαιμία, from ὑπο- hypo- 'under' + γλυκύς glykys 'sweet' + αἷμᾰ haima 'blood'.

See also [edit]

  • Diabetic Hypoglycemia (journal)
  • Idiopathic hypoglycemia
  • Neonatal hypoglycemia

References [edit]

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  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, Service FJ (March 2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J. Clin. Endocrinol. Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.
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External links [edit]

Classification

D

  • ICD-10: E16.0-E16.2
  • ICD-9-CM: 250.8, 251.0, 251.1, 251.2, 270.3, 775.6, 962.3
  • MeSH: D007003
  • DiseasesDB: 6431
External resources
  • MedlinePlus: 000386
  • eMedicine: emerg/272 med/1123 med/1939 ped/1117
  • Patient UK: Hypoglycemia
  • The National Diabetes Information Clearinghouse
  • Hypoglycemia at the Mayo Clinic
  • American Diabetes Association
  • "Hypoglycemia". MedlinePlus. U.S. National Library of Medicine.

Quizlet Which Baby Should the Nurse Know Is at Risk for Hypoglycemia

Source: https://en.wikipedia.org/wiki/Hypoglycemia

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