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| == Hypoglycemia == | | ==Background== |
| === Diagnosis ===
| | *[[Adrenal Insufficiency]] |
| *Glucose <45 in symptomatic neonate | | *[[Hypoglycemia (peds)]] |
| *Glucose <35 in asymptomatic neonate | | *[[Inborn errors of metabolism]] |
| *Most common features: vomiting, AMS, poor feeding
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| **May also see lethargy, apnea, sz | |
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| ===Etiology=== | | ==References== |
| | <References/> |
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| #Inadequate oral intake
| | [[Category:Endocrinology]] |
| #Excess insulin
| | [[Category:Pediatrics]] |
| ##Newborns of diabetic mothers
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| #Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
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| #Fatty acid oxidation or carbohydrate metabolism disorders
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| #Prematurity (inadequate glycogen stores)
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| #Sepsis
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| ===Work-Up===
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| *Rapid glucose
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| *UA
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| **If ketones: adrenal or GH deficiency, inborn errors of metabolism
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| **If no ketones: Hyperinsulinemia, fatty acid oxidation defects
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| *Glucagon 0.3 mg/kg IM or IV
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| **If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency)
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| ===Treatment===
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| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" width="100%"
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Patient Age
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| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Dextrose Bolus Dose
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| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Dextrose Maintenance Dosage
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| ! valign="top" bgcolor="#ffffff" align="left" rowspan="0" | Other Treatments to Consider
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Neonate
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | D10 5 mL/kg PO/NG/IV/IO
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 6 mL/kg/h D10
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Glucagon, 0.3 milligram/kg IM
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hydrocortisone, 25 grams PO/IM/IV/IO
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="4" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Infant
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | D10 5 mL/kg PO/NG/IV/IO
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="4" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 6 mL/kg/h D10
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Glucagon, 0.3 milligram/kg IM
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | ''or''
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hydrocortisone, 25 grams PO/IM/IV/IO
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | D25 2 mL/kg
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" |
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Child
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | D25 2 mL/kg PO/NG/IV/IO
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 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
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Glucagon, 0.3 milligram/kg/IM
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hydrocortisone, 50 grams PO/IM/IV/IO
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Adolescent
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | —
| |
| | valign="top" bgcolor="#ffffff" class="font12" align="left" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | 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
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Glucagon, 0.3 milligram/kg IM
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| |- class="font12" style="font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;"
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| | valign="top" bgcolor="#ffffff" class="font12" align="left" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin-top: 0px; margin-bottom: 9px; margin-left: 0px; margin-right: 0px;" | Hydrocortisone, 100 grams PO/IM/IV/IO
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| |}
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| ==Inborn Errors of Metabolism==
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| ===Background===
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| *Clinical manifestations are due to accumulation of toxic metabolites
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| *Must rule-out sepsis (more common in these pts)
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| ===Diagnosis===
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| *Encephalopathy
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| *Hypoglycemia
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| *Hepatic dysfunction
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| *Nonspecific complaints: lethargy, irritability, N/V
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| ===Work-Up===
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| *Glucose level
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| *UA (ketones)
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| *Chemistry
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| **Anion gap a/w organic acidemias
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| *LFT
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| *Ammonia
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| **Should be <200 in normal neonate (higher suggests urea cycle disorders)
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| *Lactate
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| *VBG
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| ===Treatment===
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| #NS 20 mL/kg boluses
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| ##Increase renal excretion of toxic metabolites
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| #Keep NPO
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| ##Removes potential inciting metabolic substrates
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| ##Provide D10 at 2x usual maintenance rates
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| #Hyperammonemia
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| ##<500
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| ###(Na phenylacetate & Na benzoate) 250mg/kg in D10 over 90min; then 250 mg/kg/d infusion
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| ###Arginine 210mg/kg IV/IO in D10 over 90min; then 210 mg/kg/d infusion
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| ##>600
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| ###Dialysis
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| #Cerebral edema
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| ##Hyperammonemia is risk factor
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| ###Give mannitol 0.5gm/kg IV/IO
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| ###Do not give steroids (worsens hyperammonemia)
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| == Source ==
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| Tintinalli
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| [[Category:Peds]] | |
