Hypoglycaemia — Viva

Opening (30 s)

"Hypoglycaemia — give a one-line definition and the single most important immediate risk."

Model: 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. The immediate risk is permanent neurological injury or death from delayed treatment; the immediate treatment is glucose — 15-20 g orally if the patient can swallow, IV 10% dextrose or IM glucagon 1 mg if not.^[2]

Station 1 — Pathophysiology (2 min)

Explain the mechanism chain from cause to clinical features and one major complication.

Station 2 — Clinical diagnosis (2 min)

Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.

Red flag cue: Altered conscious level, seizure, or coma with capillary glucose under 3.0 mmol/L — severe hypoglycaemia; treat now (IV dextrose or IM glucagon), do not wait for lab. In sulfonylurea overdose add octreotide 50 mcg SC/IV with further 50 mcg doses 6-hourly and observe 12 h after therapy stops.^[3]

Station 3 — Investigations (2 min)

First-line tests, definitive tests, and any named score with exact components.

Station 4 — Emergency management (3 min)

ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.

Station 5 — Definitive / long-term care (2 min)

Stepwise definitive therapy, monitoring, complications of treatment, follow-up.

Station 6 — Special populations (2 min)

Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.

Station 7 — Evidence & pitfalls (2 min)

Landmark trial or guideline name if standard; three classic exam traps.

Station 8 — Rapid-fire pearls (1 min)

Five high-yield facts a candidate must not forget under time pressure.

Examiner pass criteria

• Speaks in mechanisms and numbers, not vague lists
• Gives at least one exact dose or threshold
• Names escalation criteria
• Avoids dangerous delays (imaging when unstable, etc.)

References3ShowHide

1. [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. [2]Villani M, de Courten B, Zoungas S. Emergency treatment of hypoglycaemia: a guideline and evidence review Diabet Med, 2017.PMID 28477413
3. [3]Glatstein M, Scolnik D, Bentur Y. Octreotide for the treatment of sulfonylurea poisoning Clin Toxicol (Phila), 2012.PMID 23046209