Adams and Victor's Principles of Neurology, 9e
Encephalopathy, Etiology, Clinical Features.
Topics Discussed: encephalopathy, hypoglycemic; metabolic brain diseases; reactive hypoglycemia.
Excerpt:"This condition is now relatively infrequent but is an important
cause of confusion, convulsions, stupor, and coma; as such, it merits
separate consideration as a metabolic disorder of the brain. The
essential biochemical abnormality is a critical lowering of the
blood glucose. At a level of about 30 mg/dL, the cerebral
disorder takes the form of a confusional state and one or more seizures
may occur; at a level of 10 mg/dL, there is coma that may
result in irreparable injury to the brain if not corrected immediately
by the administration of glucose. As with most other metabolic encephalopathies,
the rate of decline of blood glucose is a factor in both the depression
of consciousness and residual dementia.The most common causes of hypoglycemic encephalopathy are: (1)
accidental or deliberate overdose of insulin or an oral diabetic
agent; (2) islet cell insulin-secreting tumor of the pancreas; (3) depletion
of liver glycogen, which occasionally follows a prolonged alcoholic
binge, starvation, or any form of severe liver failure; (4) glycogen
storage disease of infancy; and (5) an idiopathic hypoglycemia in
the neonatal period and infancy; (6) subacute and chronic hypoglycemia
from islet cell hypertrophy and islet cell tumors of the..."
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