Difference between revisions of "Non-neonatal hypoglycemia (peds)"

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==DDX==
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''This page is for <u>non-neonatal pediatric</u> hypoglycemia. See [[hypoglycemia]] for adult patients or [[neonatal hypoglycemia]].''
# Ingestions (e.g. ETOH)
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==Background==
# Metabolic dz^
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===Etiology===
# Sepsis
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*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
 +
*Etoh exposure (children have low glycogen stores)
  
^Save blood tubes b/f treatment
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==Clinical Features==
 +
*Most common features: vomiting, altered mental status, poor feeding
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**May also see lethargy, apnea, seizure
  
==Treatment==
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==Differential Diagnosis==
 +
*Ingestions (e.g. ETOH)
 +
*Metabolic disease^
 +
*[[Sepsis (peds)|Sepsis]]
 +
 
 +
==Evaluation==
 +
===Work-Up===
 +
*Blood glucose level
 +
*[[Urinalysis]]
 +
**If ketones: adrenal or GH deficiency, inborn errors of metabolism
 +
**If no ketones: Hyperinsulinemia, fatty acid oxidation defects
 +
 
 +
===Diagnosis===
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*Blood glucose <45 in symptomatic neonate
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*Blood glucose <35 in asymptomatic neonate
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 +
==Management==
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''See [[critical care quick reference]] for doses by weight
 
*Glucose
 
*Glucose
**Bolus D10W 2mL/kg; then infuse D10W @ 0.06-0.08mL/kg/min
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**Bolus [[D10W]] 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
*Glucagon
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*[[Glucagon]]
 
**Used for persistent hypoglycemia despite glucose administration
 
**Used for persistent hypoglycemia despite glucose administration
**0.03 mg/kg subq/IV
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**Will not work with etoh exposure as glycogen stores are already low
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**0.03mg/kg IM/IV
  
{| class="pbNotSortable" width="200" cellspacing="1" cellpadding="1" border="1"
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{{Pediatric hypoglycemia chart}}
| Age
 
| Tx
 
| Def
 
|-
 
| <2mo
 
| D10W
 
| (glu <40)
 
|-
 
| 2mo-8yrs
 
| D25W
 
| (glu <60)
 
|-
 
| >8yrs
 
| D50W
 
| (glu <70)
 
|}
 
Dose all = 2mL/kg IV  (may use 4mL/kg for D10W) or use the Rule of 50 (5cc/kg for D10, 2cc/kg for D25, 1cc/kg for D50)
 
  
^recheck in all Q5min and repeat dose if low
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==Disposition==
 +
*
  
 
==See Also==
 
==See Also==
[[Hypoglycemia (Neonatal)]]
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*[[Hypoglycemia]]
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*[[Neonatal hypoglycemia]]
  
[[Hypoglycemia]]
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==References==
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<References/>
  
[[Category:Peds]]
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[[Category:Pediatrics]]
[[Category:Endo]]
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[[Category:Endocrinology]]

Latest revision as of 16:17, 15 March 2019

This page is for non-neonatal pediatric hypoglycemia. See hypoglycemia for adult patients or neonatal hypoglycemia.

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
  • Etoh exposure (children have low glycogen stores)

Clinical Features

  • Most common features: vomiting, altered mental status, poor feeding
    • May also see lethargy, apnea, seizure

Differential Diagnosis

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

Evaluation

Work-Up

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

Diagnosis

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

Management

See critical care quick reference for doses by weight

  • Glucose
    • Bolus D10W 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
  • Glucagon
    • Used for persistent hypoglycemia despite glucose administration
    • Will not work with etoh exposure as glycogen stores are already low
    • 0.03mg/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

Disposition

See Also

References