Metabolic emergencies (peds)

Hypoglycemia

Diagnosis

• Glucose <45 in symptomatic neonate
• Glucose <35 in asymptomatic neonate
• Most common features: vomiting, AMS, poor feeding
  • May also see lethargy, apnea, sz

Etiology

1. Inadequate oral intake
2. Excess insulin
   1. Newborns of diabetic mothers
3. Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
4. Fatty acid oxidation or carbohydrate metabolism disorders
5. Prematurity (inadequate glycogen stores)
6. Sepsis

Work-Up

• Rapid glucose
• UA
  • If ketones: adrenal or GH deficiency, inborn errors of metabolism
  • If no ketones: Hyperinsulinemia, fatty acid oxidation defects
• Glucagon 0.3 mg/kg IM or IV
  • If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency)