A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection
- Skin, mucous membranes, and sclerae (white part of the eye) [Autonomic signs (synonym: adrenergic signs) – these result from reactive adrenaline release. These signs include:
- Paleness
- Ravenous hunger
- Sweating
- Tremor (shaking)]
- Abdomen (abdomen)
- Shape of the abdomen?
- Skin color? Skin texture?
- Efflorescences (skin changes)?
- Pulsations? Bowel movements?
- Visible vessels?
- Scars? Hernias (fractures)?
- Skin, mucous membranes, and sclerae (white part of the eye) [Autonomic signs (synonym: adrenergic signs) – these result from reactive adrenaline release. These signs include:
- Auscultation (listening) of the heart [tachycardia? (palpitations)]
- Auscultation of the lungs
- Examination of the abdomen
- Auscultation of the abdomen [vascular or stenotic sounds?]
- Percussion (tapping) of the abdomen.
- [Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
- Hepatomegaly (liver enlargement) and/or splenomegaly (spleen enlargement): estimate liver and spleen size]
- Palpation of the abdomen (tenderness?, tapping pain?, coughing pain?, guarding?, hernial orifices?, renal bed tenderness?).
- Inspection
- Neurological examination – due toneuroglycopenic signs: These signs result from glucose deficiency in the central nervous system (CNS) (occurrence usually only at blood glucose concentrations < 50 mg/dl). [Glycopenia affects numerous neuronal functions and manifests as follows, among others:
- Atypical behavior (aggressiveness; anxiety).
- Drowsiness
- Paresthesias (non-painful sensation in the area supplied by a cutaneous nerve with signs such as: Tingling, “formication”, furriness, tingling, itching, etc.).
- Speech disorders (aphasia)
- Visual disturbances (blurred vision, double vision).
- Confusion
- Transient hemiplegia (temporary hemiplegia).
- Psychosis or delirium If blood glucose levels continue to fall (< 30-40 mg/dl), severe neurological disorders develop:
- Epilepsy (seizures).
- Unconsciousness
- Coma]
- Health check
Square brackets [ ] indicate possible pathological (pathological) physical findings.