Hypoglycemia
Diagnosis
Glucose < 50 there are 28% with disorder
Send lytes: if Glucose < 50:
1. U/A: Ketones and Urine organic acids
2. Add cortisol to lytes
3. Insulin if no ketones in urine
9,000 glucoses sent--only 40 kids < 50 glucose
40 kids: 6 w/ fatty acid oxidation defect
3 pts w/ endocrine causes of hypoglycemia
BUN is often elevated in FAOD
History is key:
-Difficulty weaning bottle
-Longest fast
Full labs include (if very low sugar)
-LFTs/Hepatomegaly--Glycogen storage
-GH/Cortisol: 'accelerated starvation'/ketotic hypoglycemia or glycogen synthase disorder
If no ketones:
-Exogenous insulin
-insulinoma
-nesidioblastosis
Critical labs: VBG, Lytes, lactate, NH3, Serum AAs, carnitine, Urine AAs, acylcarnitine, pyruvate.
If glucose < 50:
Plasma glucose, Insulin, GH, Cortisol, free fatty acids, total and free carnitine, U/A for ketones, acyl-carnitine, acyl-glycines.
Treatment
- hypoG from sulfonylureas
- not expected if taking just metformin or thiazolidinedione- but if these are added to sulfonyl regimen, may get hypoG
- repaglinide can potentially cause hypoG but if skip next dose, should revere
- mostly from sulfonylureas
- ABC's
- Charcoal
- No emetic agents as airway problem as pt get depressed with hypoG
- Consid admit for obs because of long duration of action and delayed clearance- even if pt euglycemic at presentation
- Admit for obs even if only one tablet OD
- Octreotide- inhibits secretion of insulin among others and can be used for sulfonylurea OD with hypoG
- Dextrose itself is an insulin stimulator paradoxically
- Octreotide will treat hyperinsulinism caused by both sulfonyls and dextrose
- Diazoxide- nondiuretic vasodilator used for HTN emergency. Does not suppress insulin lvls like octreotide and therefore is second line to octreotd
- Glucagon- hormone that stimulates hepatic gluconeogenesis- efficacy dependent on hepatic glycogen stores. Not as fast as iv dextrose. Used if can't get iv established- give im
See Also
Endo: Diabetic Meds
Peds: Hypoglycemia (Peds)
Peds: Hypoglycemia (Neonatal)
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Source
7/2/09 PANI