Ng Ching Luen
Department of Family Medicine, Kowloon West Cluster, Hospital Authority, Hong Kong.
Aust Fam Physician. 2010 Jun;39(6):399-404.
Hypoglycaemia can have serious consequences for patients. Hypoglycaemia in nondiabetic patients is not a common condition, and is often a diagnostic challenge for general practitioners.
To search for evidence based guidelines on diagnosis and management of hypoglycaemia in nondiabetic adult patients and to see how these guidelines can be applied in general practice.
The Endocrine Society clinical practice guideline 2009 recommends evaluation and management of hypoglycaemia only in patients in whom Whipple's triad is documented: symptoms and/or signs of hypoglycaemia; low plasma glucose; and resolution of symptoms and/or signs after plasma glucose returns to normal. The first step in evaluation is to pursue clinical clues to specific aetiologies, ie. drugs, critical illnesses, hormone deficiencies and nonislet cell tumours. In a seemingly well individual, the differential diagnosis of hypoglycaemic disorder narrows to drug induced hypoglycaemia; accidental, surreptitious, or malicious hypoglycaemia; endogenous hyperinsulinism; and idiopathic postprandial hypoglycaemia. When a spontaneous hypoglycaemic episode cannot be observed, patients should be referred for a prolonged fasting test or a mixed meal test.
低血糖对患者可能产生严重后果。非糖尿病患者发生低血糖并不常见，且往往是全科医生面临的诊断难题。
寻找关于非糖尿病成年患者低血糖诊断和管理的循证指南，并探讨这些指南如何应用于全科医疗。
2009年内分泌学会临床实践指南建议仅对符合Whipple三联征的患者进行低血糖评估和管理，即：低血糖的症状和/或体征；血糖水平低；血糖恢复正常后症状和/或体征缓解。评估的第一步是寻找特定病因的临床线索，即药物、危重病、激素缺乏和非胰岛细胞瘤。在看似健康的个体中，低血糖症的鉴别诊断范围缩小到药物性低血糖；意外、隐匿或恶意低血糖；内源性高胰岛素血症；以及特发性餐后低血糖。当无法观察到自发性低血糖发作时，应将患者转诊进行延长禁食试验或混合餐试验。
