Non-neonatal hypoglycemia (peds): Difference between revisions
(Text replacement - "*UA" to "*Urinalysis") |
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==Evaluation== | ==Evaluation== | ||
===Work-Up=== | ===Work-Up=== | ||
*Blood glucose level | *Blood glucose level | ||
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**If ketones: adrenal or GH deficiency, inborn errors of metabolism | **If ketones: adrenal or GH deficiency, inborn errors of metabolism | ||
**If no ketones: Hyperinsulinemia, fatty acid oxidation defects | **If no ketones: Hyperinsulinemia, fatty acid oxidation defects | ||
===Diagnosis=== | |||
*Blood glucose <45 in symptomatic neonate | |||
*Blood glucose <35 in asymptomatic neonate | |||
==Management== | ==Management== |
Revision as of 16:10, 15 March 2019
Background
Etiology
- Inadequate oral intake
- Excess insulin
- Newborns of diabetic mothers
- Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
- Fatty acid oxidation or carbohydrate metabolism disorders
- Prematurity (inadequate glycogen stores)
- Sepsis
- Etoh exposure (children have low glycogen stores)
Clinical Features
- Most common features: vomiting, altered mental status, poor feeding
- May also see lethargy, apnea, seizure
Differential Diagnosis
- Ingestions (e.g. ETOH)
- Metabolic disease^
- Sepsis
Evaluation
Work-Up
- Blood glucose level
- Urinalysis
- If ketones: adrenal or GH deficiency, inborn errors of metabolism
- If no ketones: Hyperinsulinemia, fatty acid oxidation defects
Diagnosis
- Blood glucose <45 in symptomatic neonate
- Blood glucose <35 in asymptomatic neonate
Management
See critical care quick reference for doses by weight
- Glucose
- Bolus D10W 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
- Glucagon
- Used for persistent hypoglycemia despite glucose administration
- Will not work with etoh exposure as glycogen stores are already low
- 0.03mg/kg IM/IV
Pediatric Hypoglycemia Dextrose Chart
Category | Age | Glucose | Treatment | Initial IV Bolus | Maintenance Dose |
Neonatal | <2mo | <40 | D10W | 2.5-5 mL/kg | 6 mL/kg/h |
Pediatric | 2mo-8yrs | <60 | D25W | 2 mL/kg |
D10W:
|
Adult | >8yrs | <70 | D50W | 50mL (1 amp) OR 1 mL/kg |
- Consider diluting the D25W or D50W bolus, with NS 1-to-1, as those concentrations may be sclerosing to veins
- Recheck 5 minutes after dose and repeat dose if low.
- Consider glucagon IM/SQ if IV access is not readily available