Paediatrics: Glucose - Hypoglycaemia

Glucose: hypoglycaemia

In infants and children, this emergency is defined as a blood value <2.2–2.6mmol/L.

Aetiology

Hypoglycaemia is a sign of an underlying disease process that interferes with carbohydrate intake or absorption, gluconeogenesis, or glycogenolysis. Outside the neonatal period, in the acute setting, the causes of hypoglycemia can be grouped as follows.

Endocrine

• Hyperinsulinism.
• Hypopituitarism.
• Growth hormone deficiency.
• Hypothyroidism.
• Congenital adrenal hyperplasia.

Metabolic

• Glycogen storage disease.
• Galactosaemia.
• Organic acidaemia.
• Ketotic hypoglycaemia.
• Carnitine deficiency.
• Acyl CoA dehydrogenase deficiency.

Toxic

• Salicylates.
• Alcohol.
• Insulin.
• Valproate.

Hepatic

• Hepatitis.
• Cirrhosis.
• Reye syndrome.

Systemic

• Starvation.
• Malnutrition.
• Sepsis.
• Malabsorption.

Clinical assessment

Take a thorough history and identify the timing of hypoglycaemia in relation to feeding and medication. On examination assess for:

• Short stature.
• Failure to thrive
• Hepatomegaly.
• Features of any generalized metabolic disorder.

Investigation

If possible, during an acute episode you should try to:

• Save blood and urine for metabolic and endocrine testing.
• Check blood glucose in the laboratory.
• Blood electrolytes, urea, liver function, and osmolality.
• Blood gas.
• Toxicology screen.

Monitoring

Ensure ABCs. Then start with continuous pulse oximetry and ECG monitoring, and intermittent BP monitoring.

Treatment

Asymptomatic child

Oral glucose drink or gel.

Symptomatic child

• Glucose: 10% 5–10mL/kg IV, or 25% 2–4mL/kg IV.
• Followed by: continuous infusion of salt solution with 5–10% glucose(6–8mg/kg/min), e.g. 0.45% saline and 5% glucose.
• If hypoglycaemia persists increase the glucose to 10–12mg/kg/min.
• If there is no response consider glucagon, hydrocortisone, or diazoxide. These patients will need advice from a specialist.