Difference between revisions of "Non-neonatal hypoglycemia (peds)"
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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 [[DM|diabetic mothers]] | ||
| + | *Deficient hyperglycemic hormones (growth or [[CAH|adrenal hormone deficiency]]) | ||
| + | *[[Inborn errors of metabolism]]: fatty acid oxidation or carbohydrate metabolism disorders | ||
| + | *Prematurity (inadequate glycogen stores) | ||
| + | *[[Sepsis (peds)|Sepsis]] | ||
| + | *[[ETOH]] exposure (children have low glycogen stores) | ||
| + | |||
| + | ==Clinical Features== | ||
| + | *Most common features: | ||
| + | **[[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=== | ||
| + | *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 | *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== | ||
| + | * | ||
==See Also== | ==See Also== | ||
| − | [[Hypoglycemia | + | *[[Hypoglycemia]] |
| + | *[[Neonatal hypoglycemia]] | ||
| − | + | ==References== | |
| + | <References/> | ||
| − | [[Category: | + | [[Category:Pediatrics]] |
| − | [[Category: | + | [[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.
Contents
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 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