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Hypoglycemic Seizure Pathophysiology

Diabetic Seizures – What Are They? Symptoms, Causes, And Treatments

Diabetic Seizures – What Are They? Symptoms, Causes, And Treatments

A diabetic seizure is a serious medical condition and without emergency treatment, it has proven to be fatal. Extremely low levels of sugar in the diabetic’s blood cause these seizures. That is why it is so important for those who have diabetes to monitor and control their blood sugar. What Are the Causes? A number of different things can actually cause a diabetic seizure to occur. It could happen because too much insulin is injected, or because the diabetic did not eat right after taking insulin. Some of the other potential causes include not eating meals regularly or drinking too much alcohol. Even certain oral diabetes medications can make the body produce excess insulin. Those who are exercising too much without taking into account how this will affect their insulin levels will also be at a greater risk of suffering a diabetic stroke. No matter what causes the seizure, it is always a medical emergency and those who have one need immediate medical attention. What Are the Symptoms? When entering the first stages of a diabetic seizure, the person may exhibit a number of different symptoms. Some of the most common symptoms include: Sweating Clamminess Drowsiness Confusion Bodily shakes Hallucinations Rapid and unexpected emotional changes Weakness in the muscles Anxiety Vision changes Loss of ability to speak clearly After these initial symptoms, the next phase of symptoms begin and the danger level rises. Now, the person may stare into space and be non-communicative and uncontrollable body movements and contractions of the muscles may occur. In some cases, the diabetic will be unaware of the movements and may even fall into unconsciousness. What Is the Prevention and Treatment? The best way to deal with this problem is by ensuring it does not occur in the first place Continue reading >>

Anesthesia-related Perioperative Seizures: Pathophysiology, Predisposing Factors And Practical Recommendations

Anesthesia-related Perioperative Seizures: Pathophysiology, Predisposing Factors And Practical Recommendations

1Department of Anesthesiology, Ohio State University, USA 2Department of Neurological Surgery, Ohio State University, USA *Corresponding author: Alix Zuleta-Alarcon, Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Doan Hall N 411, 410 W 10th Ave, Columbus, OH. 43210, USA. Abstract Epilepsy is one of the most prevalent neurological disorders both in the United States and worldwide. It is present in 0.5-1% of the population, with a 10% lifetime risk of experiencing a single seizure. Anesthesiologists are frequently faced with the management of seizures in epileptic and nonepileptic patients in the intraoperative, emergency, or intensive care unit settings. This review aims to provide an update on the pathophysiology, clinical presentation and treatment strategies of perioperative seizures and the pro- and anti-convulsant properties of anesthetic agents, focused on neurosurgical populations. Many aspects of anesthesia may affect seizure incidence in the perioperative setting, including changes in antiepileptic drug regimen causing sub therapeutic antiepileptic drug (AED) blood levels, nil per os (NPO) status, anxiety, sleep deprivation, and drug interactions. Several general anesthetics and drugs used during anesthesia possess pro-convulsant properties that may trigger clinical seizures at induction or emergence. Anesthetic-induced epilepsy has been described during anesthesia with sevoflurane, isoflurane, etomidate, local anesthetics, opioids, propofol, as well as other anesthetics and auxiliary drugs. In neurosurgical patients, perioperative seizure risk is highly relevant, especially in patients with brain tumors, subarachnoid hemorrhage (SAH) and traumatic brain injury (TBI). Although common in practice, routine antiepileptic prophylaxis Continue reading >>

What Is The Difference Between Hyperglycemia And Hypoglycemia?

What Is The Difference Between Hyperglycemia And Hypoglycemia?

By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV What Is Hyperglycemia? In relation to diabetes, hyperglycemia refers to chronically high blood glucose levels. Most medical professionals define hyperglycemia by using the blood glucose goals that you and your physician have established and combining those goals with the blood glucose target ranges set by the American Diabetes Association. It's important to understand that you'll probably experience high blood glucose levels from time to time, despite your best efforts at control. As with any chronic disease, talk with your physician and diabetes care team if the pattern of your blood glucose readings is consistently higher or lower than your blood glucose goals. Complications from Hyperglycemia Persistent hyperglycemia can cause a wide range of chronic complications that affect almost every system in your body. When large blood vessels are affected, it can lead to: Stroke (cerebral vascular disease) Heart attack or Congestive Heart Failure (coronary heart disease) Circulation disorders and possible amputation (peripheral vascular disease) When smaller blood vessels are affected, it can lead to: Kidney disease (nephropathy) Nerve damage (neuropathy) Diabetic eye disease (retinopathy) Joseph Monks: Writer, Producer, and Film Director Joseph Monks, who has diabetic retinopathy, creates and produces films for his production company Sight Unseen Pictures. He is also the first blind filmmaker to direct a feature film. Says Joe, "I'm not uncomfortable with the term 'blind.' I'm not thrilled about it, of course, but it's accurate. The lights went out for me in early 2002 as a result of diabetic retinopathy—the death of my retinas. It is what it is, so when it happened, I decided that I wasn't going to let it put an en Continue reading >>

Hypoglycemia

Hypoglycemia

Print Overview Hypoglycemia is a condition characterized by an abnormally low level of blood sugar (glucose), your body's main energy source. Hypoglycemia is commonly associated with the treatment of diabetes. However, a variety of conditions, many of them rare, can cause low blood sugar in people without diabetes. Like fever, hypoglycemia isn't a disease itself — it's an indicator of a health problem. Immediate treatment of hypoglycemia involves quick steps to get your blood sugar level back into a normal range — about 70 to 110 milligrams per deciliter, or mg/dL (3.9 to 6.1 millimoles per liter, or mmol/L) — either with high-sugar foods or medications. Long-term treatment requires identifying and treating the underlying cause of hypoglycemia. Symptoms Similar to the way a car needs gas to run, your body and brain need a constant supply of sugar (glucose) to function properly. If glucose levels become too low, as occurs with hypoglycemia, it can cause these signs and symptoms: Heart palpitations Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability Tingling sensation around the mouth Crying out during sleep As hypoglycemia worsens, signs and symptoms may include: Confusion, abnormal behavior or both, such as the inability to complete routine tasks Visual disturbances, such as blurred vision Seizures Loss of consciousness People with severe hypoglycemia may appear as if they're intoxicated. They may slur their words and move clumsily. Many conditions other than hypoglycemia may cause these signs and symptoms. A blood sample to test your blood sugar level at the time of these signs and symptoms is how to know for sure that hypoglycemia is the cause. When to see a doctor Seek a doctor's help immediately if: You have what may be symptoms of hypoglycemia an Continue reading >>

Scientists Explain How Alcohol Causes Hypoglycemia (too Low Blood Sugar)

Scientists Explain How Alcohol Causes Hypoglycemia (too Low Blood Sugar)

Adapted Media Release Scientists at the leading Swedish medical university Karolinska Institutet have now disclosed the mystery how alcohol may cause exaggerated insulin secretion resulting in severe hypoglycemia (too low blood sugar). This mechanism, which is described in the latest number of Endocrinology, explains how alcohol ingestion may harm the human brain by decreasing the blood glucose concentration to inappropriately low levels. Hypoglycemia induced by alcohol ingestion is a well known clinical problem in diabetic patients. However, the mechanisms underlying this phenomenon have largely remained elusive. Since insulin secretion can be rapidly tuned by changes in pancreatic microcirculation, scientists at the Stockholm South Hospital Diabetes Research Center, Karolinska Institutet, evaluated the influence of alcohol administration on pancreatic islet blood flow and dynamic changes in insulin secretion and blood sugar levels. "We have now found that alcohol exerts substantial influences on pancreatic microcirculation by evoking a massive redistribution of pancreatic blood flow from the exocrine into the endocrine (insulin-producing) part via mechanisms mediated by the messenger molecule nitric oxide and the vagus nerve, augmenting late phase insulin secretion, and thereby evoking hypoglycemia" says lead investigator Åke Sjöholm. According to Professor Sjöholm the discovery is very important. This novel mechanism may in part underlie the well known hypoglycemic properties of alcohol in diabetic patients or in alcoholics with hepatic failure. Investigators note that their study might also be relevant to "the derailed metabolic situation in diabetic subjects." Alcohol intake might provoke sustained hypoglycemia in type 2 diabetes patients being treated with hypo Continue reading >>

Low Blood Sugar (hypoglycemia) (cont.)

Low Blood Sugar (hypoglycemia) (cont.)

A A A Common causes of low blood sugar include the following: Overmedication with insulin or antidiabetic pills (for example, sulfonylurea drugs) Use of medications such as beta blockers, pentamidine, and sulfamethoxazole and trimethoprim (Bactrim, Septra) Missed meals Reactive hypoglycemia is the result of the delayed insulin release after a meal has been absorbed and occurs 4-6 hours after eating. Severe infection Adrenal insufficiency Liver failure Congenital, genetic defects in the regulation of insulin release (congenital hyperinsulinism) Congenital conditions associated with increased insulin release (infant born to a diabetic mother, birth trauma, reduced oxygen delivery during birth, major birth stress, Beckwith-Wiedemann syndrome, and rarer genetic conditions) Insulinoma or insulin-producing tumor Other tumors like hepatoma, mesothelioma, and fibrosarcoma, which may produce insulin-like factors What follows are expansions on the points noted above and should be incorporated within those points (such as cancer, diabetes drugs, organ failures). Most cases of hypoglycemia in adults happen in people with diabetes mellitus. Diabetes has two forms, type 1 (loss of all insulin production) and type 2 (inadequate insulin production due to resistance to the actions of insulin). People with type 1 diabetes must take insulin to control their glucose level; if they skip meals or have a decreased appetite without changing their insulin dose, they may develop hypoglycemia. Insulin is also used to treat some people with type 2 diabetes. If a person with type 1 diabetes accidentally takes too much insulin, or a person with type 2 diabetes accidentally takes too much of their oral medications or insulin, he or she may develop hypoglycemia. Even when a diabetic patient takes medi Continue reading >>

Seizures Due To Hypoglycemia (low Blood Sugar)

Seizures Due To Hypoglycemia (low Blood Sugar)

Seizures in the setting of hypoglycemia are well described. The brain needs sugar to function and when the blood sugar falls “too low”, one of the things that can happen is that the patient may have a seizure (this is usually a generalized convulsion-a tonic-clonic or Grand Mal seizure). There is no one level of blood sugar below which one has a seizure (rather the level varies from person to person). Let me explain that with an example. Lets assume you are a diabetic and you take your insulin shot but for once forget to take a meal (maybe you are a hard working executive on the run). You have a convulsion while at work and are taken to the nearest ER. There your blood sugar at the time of presentation is recorded to be 60 mg/dl. There might be another similar patient whose blood sugar falls to 52mg/dl yet he does not have a convulsion. So there is no set limit below which the brain shall have a seizure but speaking in broader terms usually the brain does not tolerate blood sugar below 60mg/dl and below 40 mg/dl most patients shall be symptomatic (either have a convulsion or be confused and obtunded. The term used for this constellation of neurological signs and symptoms as a result of hypoglycemia is NEUROHYPOGLYCEMIA). The good news though is that seizures due to hypoglycemia are readily treatable. In the ER we load the patient with glucose (usually this is given via an intravenous drip as the patient is obtunded and confused and cannot accept anything from the mouth). The blood sugar quickly rises and the seizures stop. Patients who suffer from hypoglycemic seizures do not need to be on an anti-epileptic drug. These patients do not have epilepsy. If their blood sugar does not fall down again, they will not have another seizure. Rather a meticulous search should b Continue reading >>

Dealing With Hypoglycemia

Dealing With Hypoglycemia

If you have diabetes, your concern isn’t always that your blood sugar is too high. Your blood sugar can also dip too low, a condition known as hypoglycemia. This occurs when your blood sugar levels fall below 70 milligrams per deciliter (mg/dl). The only clinical way to detect hypoglycemia is to test your blood sugar. However, without blood tests it’s still possible to identify low blood sugar by its symptoms. Early recognition of these symptoms is critical because hypoglycemia can cause seizures or induce a coma if left untreated. If you have a history of low blood sugar episodes, you may not feel symptoms. This is known as hypoglycemic unawareness. By learning to control your blood sugar, you can prevent hypoglycemic episodes. You also should take steps to ensure you and others know how to treat low blood sugar. Managing your blood sugar is a constant balancing of: diet exercise medications A number of diabetes medications are associated with causing hypoglycemia. Only those medications that increase insulin production increase the risk for hypoglycemia. Medications that can cause hypoglycemia include: Combination pills that contain one of the medications above may also cause hypoglycemic episodes. This is a reason why it’s so important to test your blood sugar, especially when making changes to your treatment plan. Some of the most common causes of low blood sugar are: skipping a meal or eating less than usual exercising more than usual taking more medication than usual drinking alcohol, especially without food People with diabetes aren’t the only ones who experience low blood sugar. If you have any of the following conditions, you may also experience hypoglycemia: weight-loss surgery severe infection thyroid or cortisol hormone deficiency Hypoglycemia affect Continue reading >>

Hypoglycemia

Hypoglycemia

Definition The condition called hypoglycemia is literally translated as low blood sugar. Hypoglycemia occurs when blood sugar (or blood glucose) concentrations fall below a level necessary to properly support the body's need for energy and stability throughout its cells. Description Carbohydrates are the main dietary source of the glucose that is manufactured in the liver and absorbed into the bloodstream to fuel the body's cells and organs. Glucose concentration is controlled by hormones, primarily insulin and glucagon. Glucose concentration also is controlled by epinephrine (adrenalin) and norepinephrine, as well as growth hormone. If these regulators are not working properly, levels of blood sugar can become either excessive (as in hyperglycemia) or inadequate (as in hypoglycemia). If a person has a blood sugar level of 50 mg/dl or less, he or she is considered hypoglycemic, although glucose levels vary widely from one person to another. Hypoglycemia can occur in several ways. Drug-induced hypoglycemia Drug-induced hypoglycemia, a complication of diabetes, is the most commonly seen and most dangerous form of hypoglycemia. Hypoglycemia occurs most often in diabetics who must inject insulin periodically to lower their blood sugar. While other diabetics also are vulnerable to low blood sugar episodes, they have a lower risk of a serious outcome than insulin-dependant diabetics. Unless recognized and treated immediately, severe hypoglycemia in the insulin-dependent diabetic can lead to generalized convulsions followed by amnesia and unconsciousness. Death, though rare, is a possible outcome. In insulin-dependent diabetics, hypoglycemia known as an insulin reaction or insulin shock can be caused by several factors. These include overmedicating with manufactured insulin, m Continue reading >>

Hypoglycemia

Hypoglycemia

Ravindra Kumar Garg MD (Dr. Garg of King George's Medical University in Lucknow, India, has no relevant financial relationships to disclose.) Zachary N London MD, editor. (Dr. London of the University of Michigan has no relevant financial relationships to disclose.) Overview The human brain primarily uses glucose as its source of energy. In certain situations, plasma glucose may fall to a dangerous level. When plasma glucose falls, hormonal and sympathoadrenal mechanisms get activated to restore glucose levels to normal. The counterregulatory mechanisms involve reduction of insulin secretion, increasing glucagon secretion, adrenergic activation, and increased growth hormone and cortisol secretion. Repeated hypoglycemia can lead to impaired awareness, increasing the risk of severe hypoglycemia up to 6-fold. Recurrent episodes of hypoglycemia impair sympathoadrenal counterregulatory responses to a subsequent episode of hypoglycemia. The mainstay of treatment of impaired awareness of hypoglycemia is the avoidance of hypoglycemia. Hypoglycemia-induced autonomic dysfunction increases the risk of another hypoglycemic episode. Hypoglycemia often goes undiagnosed, and in the advanced stage it is frequently not treated. In patients with diabetes mellitus who lose awareness of being hypoglycemic, involvement of corticolimbic brain and centers serving higher executive functions as well as the hypothalamus has been demonstrated. Manifestations of hypoglycemia are seizures, coma, persistent vegetative state, and even death. Neonatal hypoglycemic brain injury can lead to infantile spasms. Many patients with hypoglycemia present with focal neurologic signs and transient charges in MRI, mimicking stroke. MR imaging may reveal lesions in the posterior limb of the internal capsule, cereb Continue reading >>

Seizures In Young Dogs And Cats: Pathophysiology And Diagnosis

Seizures In Young Dogs And Cats: Pathophysiology And Diagnosis

Seizures in young dogs and cats have received little attention because of the ambiguous clinical nature of seizures. In human medicine, certain aspects of brain development are now thought to have a role in childhood seizures. Epileptogenesis (i.e., generation of seizures) in an immature brain is influenced by inhibitory and excitatory systems, ionic microenvironment, and degree of myelination. Developing neurons appear to be less vulnerable to damage and loss after seizure activity. Dogs and cats younger than 1 year of age are more likely to have symptomatic epilepsy. Early recognition of potential causes of seizures in young dogs and cats is important for appropriate diagnostic considerations and timely therapeutic interventions. Although the prevalence of seizures in pediatric dogs and cats is unknown, the overall incidence in the pet population is reportedly 2% to 3%.1,2 Seizures in young dogs and cats are a diagnostic dilemma for practitioners. In young animals, seizures usually signal the onset or coexistence of significant central nervous system (CNS) disease. A seizure in puppies and kittens often requires prompt medical attention with special considerations for medical management. For the purpose of this discussion, immature or young animals are defined as those younger than 6 months of age. Categorically, the neonatal period is 0 to 2 weeks of age, the socialization period is 3 to 12 weeks of age, and the juvenile period is 12 weeks of age to adult (i.e., 3 to 6 months of age).3 An immature brain is more prone to seizures than is a mature brain because of multiple changes that occur during development. Epileptogenesis (i.e., generation of seizures) in an immature brain is influenced by the inhibitory and excitatory systems, ionic microenvironment, and degree o Continue reading >>

Hypoglycemia

Hypoglycemia

Introduction Infants and children produce and use glucose at a higher turnover rate than adults, and are thus unable to maintain a normal plasma glucose concentration even after a short fast of 24-36 hours. In infants, 90% of the glucose is used by the brain, which decreases over time to reach the norm of 40% for adults. Thus, preventing hypoglycemia is very important to avoid developmental deficits. Definition of hypoglycemia <40 mg/dL, regardless of age. This definition is controversial, however, glucose levels below 40 mg/dL produces hunger and excessive catecholamine response. Symptoms Gen: Irritability, anxiety, hunger, fatigue, Neuro: HA, blurred vision, tremors, weakness, confusion, ataxia, stupor, seizures, coma GI: abdominal pain, Heme/CV: pallor, cyanosis, diaphoresis, tachycardia, Resp: tachypnea, lethargy, apnea Most symptoms can be explained through stimulation of sympathetic responses. Recurrent severe hypoglycemic episodes can lead to brain damage and intellectual impairment. History Age Dietary Intake: what types of food (carbohydrates, protein, etc), how soon after eating did hypoglycemia develop, amount of food intake Child’s PMHx Family History: sudden infant deaths, similar problems in family Evaluation of Suspected Hypoglycemia (note: if possible, collect these samples before treatment to offer chances of earlier diagnosis) Venous sample for glucose, BMP (electrolytes, BUN, Cr), LFTs, lactate, insulin level, C-peptide, growth hormone, and cortisol levels. Blood samples for substrates: FFAs, Beta-hydroxybutarate, total and free carnitine, acylcarnitines Immediately begin efforts to collect urine (bagged specimen) and send for urinalysis and urine organic acid analysis. Check urine for ketones and glucose. Differential for Hypoglycemia A good starti Continue reading >>

Encephalopathy

Encephalopathy

Encephalopathy facts Encephalopathy is a general term that means brain disease, damage, or malfunction. The major symptom of encephalopathy is an altered mental state. The causes of encephalopathy are numerous and varied; they include infections, anoxia, metabolic problems, toxins, drugs, physiologic changes, trauma, and other causes. Encephalopathy is often considered a complication of a primary problem such as alcoholic cirrhosis, kidney failure, or anoxia. Early treatment of many types of encephalopathy can eliminate, reduce, or halt the symptoms of encephalopathy. Often, cases of encephalopathy can be prevented by avoiding the many primary causes. Encephalopathy definition and overview Encephalopathy is a term that means brain disease, damage, or malfunction. Encephalopathy can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma, or death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations (for example, poor coordination of limb movements). The term encephalopathy, in most cases, is preceded by various terms that describe the reason, cause, or special conditions of the patient that leads to brain malfunction. For example, anoxic encephalopathy means brain damage due to lack of oxygen, and hepatic encephalopathy means brain malfunction due to liver disease. Additionally, some other terms either describe body conditions or syndromes that lead to a specific set of brain malfunctions. Examples of these are metabolic encephalopathy and Wernicke's encephalopathy (Wernicke's syndrome). There are over 150 different terms that modify or precede "encephalopathy" in the medical literature; the Continue reading >>

Diabetes And Seizures: What Are They? What Are The Symptoms?

Diabetes And Seizures: What Are They? What Are The Symptoms?

Having a seizure is a very serious thing. It is dangerous for the person experiencing it, and it is also scary for those nearby. Seizures can be caused for several reasons. Some people have epilepsy, which is a disorder where seizures happen often. For those without epilepsy, they are often called “provoked seizures” because they were provoked, or brought on, by something reversible. Individuals with diabetes can experience these “provoked seizures” when their blood sugar drops too low. The following article explains the difference in these, how to prevent them, and how to care for someone that is having a diabetic seizure. The difference between epilepsy and seizures Epilepsy is a seizure disorder that happens because there is an electrical storm in the brain. People have recurrent seizures that involve loss of consciousness, convulsions, abnormal behavior, disruption of senses, or all of the above. Some have an “aura” before having a seizure and know when it is going to happen. Most causes of epilepsy are unknown, however they can be triggered by flickering light, loud noises, or physical stimulation. Treatment for this condition includes medications and sometimes diet changes. A “provoked seizure” happens because something abnormal is happening in the body. This can include low sodium, fever, alcohol, drugs, trauma, or low blood sugar. The same thing happens as with epilepsy, and there is unusual activity in the brain causing abnormal movements and behaviors. Unlike epilepsy though, where a seizure can happen for no reason, there is an actual cause for each one that occurs for “provoked seizure”. It is important to understand the cause of these so that preventative measures can be taken. There is no relationship between epilepsy and diabetes. One Continue reading >>

Hypoglycemia

Hypoglycemia

Hypoglycemia, reduction of the concentration of glucose in the blood below normal levels, commonly occurring as a complication of treatment for diabetes mellitus. In healthy individuals an intricate glucoregulatory system acts rapidly to counter hypoglycemia by reducing insulin production (insulin is important in the mechanism that removes glucose from the bloodstream) and mobilizing energy reserves from the fat and liver. When this regulatory system does not operate, disproportionately large amounts of insulin in the blood result in sudden drastic falls in circulating glucose. The manifestations of hypoglycemia evolve in a characteristic pattern. Mild hypoglycemia—for example, blood glucose concentrations less than 55 mg per 100 ml (3 mmol/l)—causes hunger, fatigue, tremour, rapid pulse, and anxiety. These symptoms are known as sympathoadrenal symptoms because they are caused by activation of the sympathetic nervous system, including the adrenal medulla. Activation of the sympathetic nervous system increases blood glucose concentrations by mobilizing liver glycogen, which is the principal storage form of carbohydrate in liver and muscle. More severe hypoglycemia—for example, blood glucose concentrations less than 45 mg per 100 ml (2.5 mmol/l)—causes blurred vision, impaired thinking and consciousness, confusion, seizures, and coma. These symptoms are known as neuroglycopenic symptoms because they are indicative of glucose deprivation in the brain. Sympathoadrenal symptoms and neuroglycopenic symptoms are nonspecific and should be attributed to hypoglycemia only when relieved by either oral or intravenous administration of glucose. The principal causes of hypoglycemia can be grouped into two categories: insulin-dependent and insulin-independent. Insulin-dependen Continue reading >>

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