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Making the correct diagnosis for loss of consciousness is difficult. The core of the diagnosis of vasovagal syncope rests upon a clear description of a typical pattern of triggers, symptoms, and time course. [citation needed] It is pertinent to differentiate lightheadedness, seizures, vertigo, and low blood sugar as other causes. [citation needed]
An ectopic atrial rhythm occurring near the sinus node may also mimic Inappropriate sinus tachycardia. Syncope or pre-syncope may occur in IST patients and be the dominant symptom, with associated prodromal symptoms such as diaphoresis and visual blurring, leading to the diagnosis of vasovagal syncope and the diagnosis of IST being overlooked. [2]
The diagnosis is confirmed when the usual blood chemistries in the emergency department reveal a high blood sugar level and severe metabolic acidosis. Treatment of diabetic ketoacidosis consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous saline with potassium and other electrolytes to replace deficits ...
Associated symptoms may be felt in the minutes leading up to a vasovagal episode and are referred to as the prodrome. These consist of light-headedness, confusion, pallor, nausea, salivation, sweating, tachycardia, blurred vision, and sudden urge to defecate among other symptoms. [9] Vasovagal syncope can be considered in two forms:
Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. [1] POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, [10] including lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea ...
To assist in diagnosis, a doctor may order an HbA1c test, which measures the blood sugar average over the two or three months before the test. The more specific 6-hour glucose tolerance test can be used to chart changes in the patient's blood sugar levels before ingestion of a special glucose drink and at regular intervals during the six hours ...
There is some evidence of the existence of a so-called "adrenergic postprandial syndrome": the blood glucose level is normal, and the symptoms are caused through autonomic adrenergic response. [6] Often, this syndrome is associated with emotional distress and anxious behaviour of the patient. [7] [8]
Syncope rapidly ensues. Indeed, the short latency between the stimulus and the attack has been emphasized as an important distinction from the more familiar (at least in older children and adults) vasovagal syncope. The child loses awareness and postural tone, falling to the ground. There may be down-beat nystagmus.