Hypoglycemia requiring dextrose is most likely in which liver disease?

• A. Hepatic steatosis
• B. Well-compensated cirrhosis
• C. Decompensated cirrhosis
• D. Fulminant hepatic failure

Answer: (D)

Glucose production during fasting mainly depends on the liver’s ability to perform glycogenolysis and gluconeogenesis. In fulminant hepatic failure, hepatocytes are rapidly and extensively damaged, knocking out these glucose-producing pathways. That abrupt loss of hepatic glucose output makes hypoglycemia occur quickly and often be severe enough to require IV dextrose. By contrast, hepatic steatosis, well-compensated cirrhosis, and even decompensated cirrhosis preserve enough metabolic function for glucose production to prevent such rapid, severe hypoglycemia, at least for a time. So the situation most likely to necessitate dextrose for hypoglycemia is fulminant hepatic failure.