Non-neonatal hypoglycemia (peds)

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

Clinical Features

• Most common features: vomiting, AMS, poor feeding
  • May also see lethargy, apnea, sz

Differential Diagnosis

• Ingestions (e.g. ETOH)
• Metabolic disease^
• Sepsis

Diagnosis

• Blood glucose <45 in symptomatic neonate
• Blood glucose <35 in asymptomatic neonate

Work-Up

• Blood glucose level
• UA
  • If ketones: adrenal or GH deficiency, inborn errors of metabolism
  • If no ketones: Hyperinsulinemia, fatty acid oxidation defects

Management

See critical care quick reference for doses by weight

• Glucose
  • Bolus D10W 2mL/kg; then infuse D10W @ 0.06-0.08mL/kg/min
• Glucagon
  • Used for persistent hypoglycemia despite glucose administration
  • 0.03 mg/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

Patient Age	Dextrose Bolus Dose	Dextrose Maintenance Dosage	Other Treatments to Consider
Neonate	D10 5 mL/kg PO/NG/IV/IO	6 mL/kg/h D10	Glucagon, 0.3 milligram/kg IM
			Hydrocortisone, 25 grams PO/IM/IV/IO
Infant	D10 5 mL/kg PO/NG/IV/IO	6 mL/kg/h D10	Glucagon, 0.3 milligram/kg IM
	or		Hydrocortisone, 25 grams PO/IM/IV/IO
	D25 2 mL/kg
Child	D25 2 mL/kg PO/NG/IV/IO	6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg	Glucagon, 0.3 milligram/kg/IM
			Hydrocortisone, 50 grams PO/IM/IV/IO
Adolescent	—	6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg	Glucagon, 0.3 milligram/kg IM
			Hydrocortisone, 100 grams PO/IM/IV/IO

See Also

• Hypoglycemia
• Neonatal hypoglycemia