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== | ==Background== | ||
===Etiology=== | ===Etiology=== | ||
*Inadequate oral intake | *Inadequate oral intake | ||
*Excess insulin | *Excess insulin | ||
**Newborns of diabetic mothers | **Newborns of [[DM|diabetic mothers]] | ||
*Deficient hyperglycemic hormones ( | *Deficient hyperglycemic hormones (growth or [[CAH|adrenal hormone deficiency]]) | ||
* | *[[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) | |||
==Clinical Features== | ==Clinical Features== | ||
*Most common features: vomiting | *Most common features: | ||
**May also see lethargy, apnea, | **[[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== | ||
* | ====Systemic Illness==== | ||
* | *Critical Illness | ||
*[[ | **[[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== | |||
===Work-Up=== | ===Work-Up=== | ||
*Blood glucose level | *Blood glucose level | ||
* | *[[Urinalysis]] | ||
**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== | ||
''See [[critical care quick reference]] for doses by weight | ''See [[critical care quick reference]] for doses by weight | ||
*Glucose | *Glucose | ||
**Bolus [[D10W]] 2mL/kg; then infuse D10W | **Bolus [[D10W]] 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min | ||
*[[Glucagon]] | *[[Glucagon]] | ||
**Used for persistent hypoglycemia despite glucose administration | **Used for persistent hypoglycemia despite glucose administration | ||
**0. | **Will not work with etoh exposure as glycogen stores are already low | ||
**0.03mg/kg IM/IV | |||
{{Pediatric hypoglycemia chart}} | {{Pediatric hypoglycemia chart}} | ||
==Disposition== | ==Disposition== | ||
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<References/> | <References/> | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:FEN]] |
Latest revision as of 19:08, 6 October 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 (growth or adrenal hormone deficiency)
- Inborn errors of metabolism: 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
Systemic Illness
- Critical Illness
- Organ Failure
- Endocrinopathy
- Seizure
- Inborn errors of metabolism
Drugs
- Anti-hyperglycemic
- Insulin
- Oral secretagogue
- Other
Malignancy
- Insulinoma
- Non-islet cell
- Insulin/receptor autoantibodies
- High tumor burden
Other
- Artifactual
- Specimen collection
- Consumption
- Leukemia
- Erythrocytosis
- Hemolytic disease
- Starvation
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
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