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| | ''This page is for <u>non-neonatal pediatric</u> hypoglycemia. See [[hypoglycemia]] for adult patients or [[neonatal hypoglycemia]].'' |
| ==Background== | | ==Background== |
| ===Etiology=== | | ===Etiology=== |
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| *Prematurity (inadequate glycogen stores) | | *Prematurity (inadequate glycogen stores) |
| *Sepsis | | *Sepsis |
| | *Etoh exposure (children have low glycogen stores) |
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| ==Clinical Features== | | ==Clinical Features== |
| *Most common features: vomiting, AMS, poor feeding | | *Most common features: vomiting, altered mental status, poor feeding |
| **May also see lethargy, apnea, sz | | **May also see lethargy, apnea, seizure |
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| ==Differential Diagnosis== | | ==Differential Diagnosis== |
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| *[[Sepsis (peds)|Sepsis]] | | *[[Sepsis (peds)|Sepsis]] |
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| ==Diagnosis== | | ==Evaluation== |
| *Blood glucose <45 in symptomatic neonate
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| *Blood glucose <35 in asymptomatic neonate
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| ===Work-Up=== | | ===Work-Up=== |
| *Blood glucose level | | *Blood glucose level |
| *UA | | *[[Urinalysis]] |
| **If ketones: adrenal or GH deficiency, inborn errors of metabolism | | **If ketones: adrenal or GH deficiency, inborn errors of metabolism |
| **If no ketones: Hyperinsulinemia, fatty acid oxidation defects | | **If no ketones: Hyperinsulinemia, fatty acid oxidation defects |
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| | ===Diagnosis=== |
| | *Blood glucose <45 in symptomatic neonate |
| | *Blood glucose <35 in asymptomatic neonate |
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| ==Management== | | ==Management== |
| ''See [[critical care quick reference]] for doses by weight | | ''See [[critical care quick reference]] for doses by weight |
| *Glucose | | *Glucose |
| **Bolus [[D10W]] 2mL/kg; then infuse D10W @ 0.06-0.08mL/kg/min | | **Bolus [[D10W]] 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min |
| *[[Glucagon]] | | *[[Glucagon]] |
| **Used for persistent hypoglycemia despite glucose administration | | **Used for persistent hypoglycemia despite glucose administration |
| **0.03 mg/kg IM/IV | | **Will not work with etoh exposure as glycogen stores are already low |
| | **0.03mg/kg IM/IV |
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| {{Pediatric hypoglycemia chart}} | | {{Pediatric hypoglycemia chart}} |
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| {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 621px; height: 444px;"
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| ! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Patient Age
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| ! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Dextrose Bolus Dose
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| ! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Dextrose Maintenance Dosage
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| ! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Other Treatments to Consider
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | Neonate
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | D10 5 mL/kg PO/NG/IV/IO
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | 6 mL/kg/h D10
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Glucagon, 0.3 milligram/kg IM
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Hydrocortisone, 25 grams PO/IM/IV/IO
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="4" class="font12" | Infant
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | D10 5 mL/kg PO/NG/IV/IO
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="4" class="font12" | 6 mL/kg/h D10
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Glucagon, 0.3 milligram/kg IM
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | ''or''
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="3" class="font12" | Hydrocortisone, 25 grams PO/IM/IV/IO
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | D25 2 mL/kg
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" |
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | Child
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | D25 2 mL/kg PO/NG/IV/IO
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" |
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| 6 mL/kg/h D10 for the first 10 kg
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| + 3 mL/kg/h for 11–20 kg
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| + 1.5 mL/kg/h for each additional kg >20 kg
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Glucagon, 0.3 milligram/kg/IM
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Hydrocortisone, 50 grams PO/IM/IV/IO
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | Adolescent
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" | —
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" rowspan="2" class="font12" |
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| 6 mL/kg/h D10 for the first 10 kg
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| + 3 mL/kg/h for 11–20 kg
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| + 1.5 mL/kg/h for each additional kg >20 kg
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Glucagon, 0.3 milligram/kg IM
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| |- style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12"
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| | bgcolor="#ffffff" align="left" valign="top" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" class="font12" | Hydrocortisone, 100 grams PO/IM/IV/IO
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| |}
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| ==Disposition== | | ==Disposition== |