Hyper and hypo glycemia

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Hyper and hypo glycemia

Causes

Hypoglycemia

Seen rarely, such as in cases of starvation

Hyperglycemia

Diabetes Mellitus

Sequelae

Macrovascular damage

microvascular damage

Diabetic nephropathy

Susceptible to pyelonephritis and papillary necrosis

Presents as a glomerular syndrome

Thickening of glomerular basement membrane

allows protein to leak through

Symptoms

polyphasigia

polydipsia

polyuria

Caused by insulin deficiency or resistance

Clinical findings

electrolyte imbalance

ketonuria

low urine specific gravity

hypotonic urine

proteinuria

hyperglycemia

glycosuria

Definitions

Hypoglycemia: Low levels of glucose in the blood

Hyperglycemia: Increased glucose in the blood

Normal and Abnormal blood ranges

Renal threshold: 160-180 mg/dL

High fasting plasma glucose: >126

Normal fasting plasma glucose: 70-99 mg/dL

Glucosuria

Definition: glucose in the urine

Causes of glucosuria

1. Hyperglycemia exceeds renal threshold

2. Renal threshold is lower than normal, such as in renal glycosuria

Urinalysis tests

Clinitest

False negative: bleach or radiographic dye

False positive: Any reducing substance, such as ascorbic acid

Specificity: all reducing substances

Sensitivity: 250 mg/dL

Copper sulfate is reduced to cuprous oxide

Uses copper reduction to detect any reducing substance

Glucose dipstick method

False Negatives: ascorbic acid or improperly stored urine (glycolysis)

False positives: strong oxidizing agents and peroxides

Sensitivity: 75-125 mg/dL

Uses glucose oxidase, which produces peroxide

Peroxide reacts with chromogen, catalyzed by peroxidase, to produce oxidized chromogen

The oxidized chromogen causes a color change

Specific for glucose

Normal ranges: There should be no glucose in the urine