Hypoglycemia (Low Blood Sugar): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • Assessment of consciousness using the Glasgow Coma Scale (GCS).
  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • 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)?
    • Auscultation of the heart [tachycardia? (heartbeat too fast: > 100 beats per minute)]
    • Auscultation of the lungs
    • Examination of the abdomen
      • Auscultation (listening) of the abdomen [vascular or stenotic sounds?, bowel 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?).
  • 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]

Square brackets [ ] indicate possible pathological (pathological) physical findings.Glasgow Coma Scale (GCS) – scale for estimating a disorder of consciousness.

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
  • If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
  • With a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.