HELLP Syndrome and Hypoglycemia
Yes, HELLP syndrome can be associated with hypoglycemia, though this occurs occasionally rather than universally, and maternal blood glucose should be monitored during the perioperative period and in critically ill patients. 1
Clinical Recognition and Monitoring
Severe hypoglycemia has been specifically reported in association with HELLP syndrome and requires active surveillance. 1 The mechanism relates to hepatocellular dysfunction and impaired gluconeogenesis from the elevated liver enzymes component of the syndrome. 1
When to Monitor Blood Glucose
- Maternal blood glucose concentration should be measured during operation in patients with HELLP syndrome undergoing cesarean section 1
- Measurement of maternal acid-base status is indicated in patients with clinical or radiological evidence of pulmonary complications or blood glucose disturbance 1
- Blood glucose monitoring is particularly important in critically ill patients requiring intensive care 1
Distinguishing HELLP from Acute Fatty Liver of Pregnancy
This distinction matters because hypoglycemia occurs with different frequencies:
- The triad of jaundice, coagulopathy, and low platelets in HELLP may occasionally be associated with hypoglycemia 1
- Acute fatty liver of pregnancy (AFLP) may be associated with hypoglycemia more consistently than HELLP syndrome 2
- Women with AFLP had major hypoglycemia compared to HELLP syndrome patients 3
The key differentiating features: AFLP presents with malaise in all patients, marked hypoglycemia, hypocholesterolemia, and hypotriglyceridemia, while HELLP is more closely linked with pre-eclampsia and has headache, epigastric pain, and hematuria as common symptoms. 2, 3
Clinical Implications
Perioperative Management
- Given the hepatic involvement in HELLP syndrome, anaesthetic drugs with minimal hepatic or renal metabolism should be chosen 1
- The liver dysfunction impairs both drug metabolism and glucose homeostasis 1
- Central venous catheter placement may be necessary as these patients are often relatively hypovolemic despite appearing edematous 1
Critical Care Monitoring
- Patients should be monitored in high-dependency or intensive care settings for at least 24-48 hours post-delivery 4
- Monitoring should include blood pressure, central venous pressure, urinary output, ECG, and oxygen saturation 4
- Hypoglycemia is a marker associated with high mortality risk in severe liver dysfunction 1
Common Pitfall
Do not assume hypoglycemia is absent simply because it is not a defining feature of HELLP syndrome. The hepatocellular injury can impair gluconeogenesis unpredictably, and severe hypoglycemia when it occurs represents a medical emergency requiring immediate correction. 1 This is particularly critical during the perioperative period when patients are NPO and metabolically stressed. 1