Non-neonatal hypoglycemia (peds): Difference between revisions
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== | ''This page is for <u>non-neonatal pediatric</u> hypoglycemia. See [[hypoglycemia]] for adult patients or [[neonatal hypoglycemia]].'' | ||
==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 (peds)|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 chart}} | |||
==Disposition== | |||
* | |||
==See Also== | ==See Also== | ||
[[Hypoglycemia | *[[Hypoglycemia]] | ||
*[[Neonatal hypoglycemia]] | |||
==References== | |||
<References/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Endocrinology]] |
Revision as of 16:17, 15 March 2019
This page is for non-neonatal pediatric hypoglycemia. See hypoglycemia for adult patients or neonatal hypoglycemia.
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