Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | History of upper GI resectional surgery | Refer for dietetic advice. |
30–60 min after eating with sweating, dizziness, tachycardia | Refer for dietetic advice:
| |
Somnolence 1–3 hours after eating |
| |
First line | ||
ECG/24 hour tape | Cardiac disease | Discuss with the supervising clinician within 24 hours. |
OGD and SI aspirate (p. 25) | SIBO | Management of SIBO (p. 27). |
Glucose hydrogen methane breath test | SIBO | Management of SIBO (p. 27). |
Monitor blood glucose | If abnormally high | Refer to GP/endocrinology. |
If abnormally low | Refer for dietetic advice | |
Second line | ||
Persisting unexplained symptoms | Consider insulinoma/neuroendocrine tumour | Refer to gastroenterology/endocrinology. |
Third line | ||
If normal investigations/no response to intervention | Reassure. |
ECG, electrocardiogram; GI, gastrointestinal; GP, general practitioner; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); SI, small intestine; SIBO, small intestinal bacterial overgrowth.