MBBS OSCE · Endocrinology
OSCE — Hypoglycaemia
Eight-minute OSCE station on Hypoglycaemia: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Hypoglycaemia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1]
Clinical context
Hypoglycaemia is plasma glucose low enough to cause symptoms (typically under 3.0 mmol/L / 54 mg/dL). It produces a biphasic clinical syndrome: first autonomic / sympathetic activation (sweating, tremor, palpitations, anxiety) at glucose about 3.2 mmol/L (58 mg/dL), then neuroglycopenia (confusion, drowsiness, seizures, coma, and at its extreme, death) as glucose falls below 3.0 mmol/L. In adults in the community the dominant cause is glucose-lowering therapy in diabetes (insulin, sulfonylureas, glinides); in non-diabetics, insulinoma, non-islet cell tumour hypoglycaemia (IGF-II), adrenal insufficiency, alcohol, sepsis/critical illness, and autoimmune insulin syndrome must each be excluded. Treatment of the responsive adult is 15-20 g oral glucose or sucrose, repeated after 10-15 minutes; the unresponsive adult needs IV 10% dextrose or IM glucagon 1 mg, with octreotide added in sulfonylurea poisoning.[2]
Candidate tasks
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Clarify onset, severity, associated features, and red-flag symptoms. [1]
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State focused examination priorities.
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List first-line investigations and any named score/criteria.
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Give immediate resuscitation steps.
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Outline definitive management with doses/routes where standard.
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Name complications and disposition (ward / HDU / theatre / discharge safety-net).
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Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Altered conscious level, seizure or coma with glucose under 3.0 mmol/L — treat now (IV 10% dextrose or IM glucagon 1 mg), do not wait for the lab.[2] |
| Safety | Patient on insulin or sulfonylurea who is confused, drowsy or aggressive — check glucose before assuming a non-metabolic cause |
| Safety | Hypoglycaemia in a NON-diabetic — always abnormal; admit, draw the diagnostic trough samples during the episode, then investigate.[1] |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1]
References2ShowHide
- [1]Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline J Clin Endocrinol Metab, 2009.PMID 19088155
- [2]Villani M, de Courten B, Zoungas S. Emergency treatment of hypoglycaemia: a guideline and evidence review Diabet Med, 2017.PMID 28477413