Extensive liver disease is required to cause hypoglycemia. This can happen with fulminant hepatitis, fatty liver from starvation or alcohol ingestion, and cholangitis with biliary obstruction. Hypoglycemia is unusual with common forms of cirrhosis or hepatitis, although glucose metabolism may be altered.
Severe cardiac failure may lead to hypoglycemia; the pathogenesis is not known, but is thought to be from hepatic congestion, cellular hypoxia, or substrate limitation. Some patients with renal failure develop hypoglycemia, and this is not well understood either. It may be due to cachexia with limited substrate for glucose production or to inhibition of gluconeogenesis itself.
Sepsis commonly leads to hypoglycemia. A combination of increased glucose utilization and failure of glucose production seem to be involved.
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