# Hypoglycemia vs Heat Exhaustion



## musicislife (May 20, 2012)

are they difficult to differ from each other?


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## mycrofft (May 20, 2012)

Some similarities especially on paper. Heat exhaustion usually involves heat and not hunger. Hypoglycemia usually involves hunger and/or agitation and/or confusion and/or  anxiety.


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## EMT John (May 20, 2012)

+1 ^^^


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## Maine iac (May 20, 2012)

No.

Low sugars will be lethargic or confused or will just be weird.

Heat issues manifest when there is an environmental element as the primary equation.

Figuring out if somebody is having a stroke or a diabetic crisis is one of the harder ones to do..... until you check their sugar.


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## mycrofft (May 21, 2012)

Low sugars under say forty will get loggy, true, but early on they are agitated nervous diaphoretic etc. After six years as the RN in charge of the day shift for a diabetic/asthmatic/detox/etc section, I have some idea.


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## Akulahawk (May 21, 2012)

Maine iac said:


> No.
> 
> Low sugars will be lethargic or confused or will just be weird.
> 
> ...





mycrofft said:


> Low sugars under say forty will get loggy, true, but early on they are agitated nervous diaphoretic etc. After six years as the RN in charge of the day shift for a diabetic/asthmatic/detox/etc section, I have some idea.


Typically by the time EMS sees a low sugar problem, the patient has gotten past the agitated/nervous/diaphoretic stage and into the lethargic/confused/weird stage. That's when other people notice that there's a problem and call for help. Mycrofft's experience includes watching patients known for having these problems, so he got to watch people progress through early hypoglycemia before they get "loggy" as he says.

Unfortunately, since people tend to only notice things that are out of norm by quite a bit, by the time EMS shows up, hypoglycemia and CVA can be difficult to discern until blood sugar is checked.


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## mycrofft (May 21, 2012)

My experience working events and field deployments is the early signs are missed because folks don't know what they are. It can just as easily be a behavioral tick than low blood sugar. Also, early on sometimes folks are not classically "hungry", our have been accustomed to stop perceiving it as hunger.


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## EMT John (May 22, 2012)

Something to realize people, our OP has First Responder training. This person isn't going to be able to use any diagnostic equipment and can only go off signs & symptoms. No BS check, no IV's. Just questions and answers. So let's keep it very BLS.


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## Doczilla (May 22, 2012)

I think that every heat injury with altered mental status should get a BGL. Its easy to do,  and you don't wanna miss it when hypoglycemia does happen. Its more along the heat stroke sequelae, but its hard to draw that line in the field.


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## mycrofft (May 22, 2012)

Fingerstick glucometry is fairly innocuous, materials are available to any layperson. All that is needed is protocol and  training and equipment.


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## Brandon O (May 22, 2012)

Not sure how "heat exhaustion" became stroke...

The literature suggests that traditionally, diabetics experience a 10-20 mg/dL gap between the onset of catecholaminergic symptoms (which, remember, look just like the catecholaminergic symptoms of, oh, basically all other acute sickness? pallor, diaphoresis, agitation, tachycardia, hypertension, etc. etc.) and the onset of neurological impairment (lethargy, confusion, etc.). In my experience we tend to show up either during the latter stage or with a combination present. Most diabetics SHOULD be recognizing the early stage and taking it as their cue to gobble something down, so it's only when they become too altered to do so that EMS is involved. The trouble is that the catechol reaction can be impaired by various things, including drugs (think beta blockers) and habituation (happens a lot, their body stops bothering).

Even if you don't carry or are not authorized for glucometry, there's often a glucometer around and asking the patient or family or staff (not necessarily requesting) for the BGL can fill your assessment cup far more full than a hundred pertinent questions and sage pokes and prods.


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## mycrofft (May 22, 2012)

Like Brandon said.
The OP actually launched three posts about this, and they are running a little parallel.
Issue in the other is why as a first responder or lay first aider EMS wasn't called in for an altered LOC ?


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## the_negro_puppy (May 22, 2012)

A good history and medical hx should seriously help you differentiate before you even touch the patient


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## Doczilla (May 22, 2012)

Someone brought it up lol. Just double tapping it, but a heat injury with altered mental status is heat stroke till proven otherwise.


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## musicislife (May 22, 2012)

is learning to take a BGL difficult (i have an aunt with a diabetic daughter, i assume she could teach me) would responding EMTs get mad if I took one?


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## Remeber343 (May 22, 2012)

musicislife said:


> is learning to take a BGL difficult (i have an aunt with a diabetic daughter, i assume she could teach me) would responding EMTs get mad if I took one?



If it is in your protocols, no.  If you show up on scene with your own BGL meter and are not allowed (protocols state otherwise) to take one, then they will probably not take as kindly to it.  I would think if you are able to give oral glucose you should be able to check a BGL... but that would make to much sense... and when do they ever do that.

just stick to your protocols and you'll be in the clear.


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## musicislife (May 22, 2012)

ok then I am not allowed to take one (i can check with my captain, but i dont think i can take a BGL, just administer oral glucose, go figure) anyway so what signs and symptoms am I looking for? they seem similar to many symptoms. Is there a key indicator for hypoglycemia?


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## medichopeful (May 22, 2012)

musicislife said:


> is learning to take a BGL difficult (i have an aunt with a diabetic daughter, i assume she could teach me) would responding EMTs get mad if I took one?



Difficult?  No.  Invasive?  Legally speaking, yes, so I'd be very careful.


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## EMT John (May 23, 2012)

To answer your question i think i should elaborate the difference between Heat Exhaustion and Heat Stroke.

Heat Exhaustion:
This is usually caused by excerise, work, being outside in the heat or just not being prepared for the heat. The result of this is dehydration which will have signs and symptoms of very painful muscle cramps, headache, nausea, dizzy, dripping sweat ( Cool, Pale, daphoretic)

Heat Stoke:
This tends to lead after heat exhaustion with a rapid onset. these people are no longer sweating, lethargic or unresponsive, Hyperventalating, Dry hot skin.

You can also have both at the same time. esspecially in sports.

So going back to Heat Exhaustion vs Hypoglycemia
Sick with the Basics. SAMPLE is going to get you a lot of information on this one.


Main thing you need to do as a First responder is stabalize the pt until EMS  arrives. go through your SAMPLE, OPQRST and any other numonics that you are using and stabalize stabalize stabalize.

Stay away from figuring out ways to use equipment your not aloud to, such as glucometers and whatever else. you'll learn down the road to not watch your equipment and just watch your pt, youll get more information that way.

(apoligize for the grammer... its been one of those days)


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## mycrofft (May 23, 2012)

*Use SEARCH as well.*

See other threads about heat exhaustion and heat stroke for other takes on this.

Nothing says you can't have hypoglycemia along with a heat illness as well. In fact, virtually all the heat exhaustion cases I've seen were not eating their meals, as well as not drinking enough fluids. 

Heat stroke cases I saw, those didn't seem to matter so much.


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