Non-neonatal hypoglycemia (peds)

Differential Diagnosis

1. Ingestions (e.g. ETOH)
2. Metabolic disease^
3. Sepsis

^Save blood tubes before treatment

Treatment

See critical care quick reference for doses by weight

• Glucose
  • Bolus D10W 2mL/kg; then infuse D10W @ 0.06-0.08mL/kg/min
• Glucagon
  • Used for persistent hypoglycemia despite glucose administration
  • 0.03 mg/kg subq/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 D25W or D50W 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

See Also

Hypoglycemia (Neonatal)

Hypoglycemia

Diagnosis

• Glucose <45 in symptomatic neonate
• Glucose <35 in asymptomatic neonate
• Most common features: vomiting, AMS, poor feeding
  • May also see lethargy, apnea, sz

Etiology

1. Inadequate oral intake
2. Excess insulin
   1. Newborns of diabetic mothers
3. Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
4. Fatty acid oxidation or carbohydrate metabolism disorders
5. Prematurity (inadequate glycogen stores)
6. Sepsis

Work-Up

• Rapid glucose
• UA
  • If ketones: adrenal or GH deficiency, inborn errors of metabolism
  • If no ketones: Hyperinsulinemia, fatty acid oxidation defects
• Glucagon 0.3 mg/kg IM or IV
  • If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency)

Treatment

Patient Age	Dextrose Bolus Dose	Dextrose Maintenance Dosage	Other Treatments to Consider
Neonate	D10 5 mL/kg PO/NG/IV/IO	6 mL/kg/h D10	Glucagon, 0.3 milligram/kg IM
			Hydrocortisone, 25 grams PO/IM/IV/IO
Infant	D10 5 mL/kg PO/NG/IV/IO	6 mL/kg/h D10	Glucagon, 0.3 milligram/kg IM
	or		Hydrocortisone, 25 grams PO/IM/IV/IO
	D25 2 mL/kg
Child	D25 2 mL/kg PO/NG/IV/IO	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	Glucagon, 0.3 milligram/kg/IM
			Hydrocortisone, 50 grams PO/IM/IV/IO
Adolescent	—	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	Glucagon, 0.3 milligram/kg IM
			Hydrocortisone, 100 grams PO/IM/IV/IO