Hypoglycemia

Diagnosis

Glucose < 50 there are 28% with disorder

Send lytes: if Glucose < 50:

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:

Full labs include (if very low sugar)

LFTs/Hepatomegaly--Glycogen storage
GH/Cortisol: 'accelerated starvation'/ketotic hypoglycemia or glycogen synthase disorder

If no ketones:

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.

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

7/2/09 PANI

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