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

(Differential Diagnosis)
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^Save blood tubes before treatment
 
^Save blood tubes before treatment
  
=== Diagnosis ===
+
== Diagnosis ==
 
*Glucose <45 in symptomatic neonate
 
*Glucose <45 in symptomatic neonate
 
*Glucose <35 in asymptomatic neonate
 
*Glucose <35 in asymptomatic neonate
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**May also see lethargy, apnea, sz
 
**May also see lethargy, apnea, sz
  
===Work-Up===
+
==Work-Up==
 
*Rapid glucose
 
*Rapid glucose
 
*UA
 
*UA

Revision as of 07:51, 1 May 2015

Background

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

Differential Diagnosis

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

^Save blood tubes before treatment

Diagnosis

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

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

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 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
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

See Also

Hypoglycemia (Neonatal)

Hypoglycemia