Difference between revisions of "Non-neonatal hypoglycemia (peds)"

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*Inadequate oral intake
 
*Inadequate oral intake
 
*Excess insulin
 
*Excess insulin
**Newborns of diabetic mothers
+
**Newborns of [[DM|diabetic mothers]]
*Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
+
*Deficient hyperglycemic hormones (growth or [[CAH|adrenal hormone deficiency]])
*Fatty acid oxidation or carbohydrate metabolism disorders
+
*[[Inborn errors of metabolism]]: fatty acid oxidation or carbohydrate metabolism disorders
 
*Prematurity (inadequate glycogen stores)
 
*Prematurity (inadequate glycogen stores)
*Sepsis
+
*[[Sepsis (peds)|Sepsis]]
*Etoh exposure (children have low glycogen stores)
+
*[[ETOH]] exposure (children have low glycogen stores)
  
 
==Clinical Features==
 
==Clinical Features==
*Most common features: vomiting, altered mental status, poor feeding
+
*Most common features:  
**May also see lethargy, apnea, seizure
+
**[[nausea and vomiting (peds)|Vomiting]]
 +
**[[altered mental status (peds)|Altered mental status]]
 +
**[[failure to thrive (peds)|Poor feeding]]
 +
**May also see lethargy, apnea, [[seizure (peds)|seizure]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Ingestions (e.g. ETOH)
+
====Systemic Illness====
*Metabolic disease^
+
*Critical Illness
*[[Sepsis (peds)|Sepsis]]
+
**[[Sepsis (peds)|Sepsis]]
 +
*Organ Failure
 +
**[[Hepatic failure]]
 +
**[[Renal failure]]
 +
*Endocrinopathy
 +
**[[Adrenal insufficiency]], [[congenital adrenal hyperplasia]]
 +
*[[Seizure (peds)|Seizure]]
 +
*[[Inborn errors of metabolism]]
 +
 
 +
====Drugs====
 +
*Anti-hyperglycemic
 +
**[[Insulin]]
 +
**Oral secretagogue
 +
***[[Sulfonylurea toxicity]]
 +
*Other
 +
**[[EtOH]]
 +
**[[B-blocker]]
 +
**[[ACE inhibitor|ACEI]]
 +
**[[Acetaminophen Overdose|Acetaminophen (OD)]]
 +
 
 +
====Malignancy====
 +
*Insulinoma
 +
*Non-islet cell
 +
*Insulin/receptor autoantibodies
 +
*High tumor burden
 +
====Other====
 +
*Artifactual
 +
**Specimen collection
 +
**Consumption
 +
***[[Leukemia (peds)|Leukemia]]
 +
***Erythrocytosis
 +
***[[hemolytic anemia|Hemolytic disease]]
 +
*Starvation
 +
**[[Anorexia nervosa]]
 +
 
 +
====Precipitants of anti-hyperglycemic induced hypoglycemia====
 +
*Decreased glucose
 +
**Missed meal
 +
**Consumption (exercise, illness)
 +
*Increased drug
 +
**Error (patient, provider)
 +
**Intentional overdose
 +
**Increased availability
 +
***[[Hepatic failure]]
 +
***[[Renal failure]]
 +
***Drug interaction
  
 
==Evaluation==
 
==Evaluation==

Revision as of 16:47, 28 September 2019

This page is for non-neonatal pediatric hypoglycemia. See hypoglycemia for adult patients or neonatal hypoglycemia.

Background

Etiology

Clinical Features

Differential Diagnosis

Systemic Illness

Drugs

Malignancy

  • Insulinoma
  • Non-islet cell
  • Insulin/receptor autoantibodies
  • High tumor burden

Other

Precipitants of anti-hyperglycemic induced hypoglycemia

  • Decreased glucose
    • Missed meal
    • Consumption (exercise, illness)
  • Increased drug

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:

  • 6 mL/kg/h for first 10 kg
  • + 3 mL/kg/h for 11–20 kg
  • + 1.5 mL/kg/h for each additional kg >20 kg
Adult >8yrs <70 D50W 50mL (1 amp) OR 1 mL/kg
  • Consider diluting the D25 or D50 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

Disposition

See Also

References