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

(Differential Diagnosis)
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==Background==
 
==Background==
 
===Etiology===
 
===Etiology===
#Inadequate oral intake
+
*Inadequate oral intake
#Excess insulin
+
*Excess insulin
##Newborns of diabetic mothers
+
**Newborns of diabetic mothers
#Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
+
*Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
#Fatty acid oxidation or carbohydrate metabolism disorders
+
*Fatty acid oxidation or carbohydrate metabolism disorders
#Prematurity (inadequate glycogen stores)
+
*Prematurity (inadequate glycogen stores)
#Sepsis
+
*Sepsis
 +
 
 +
==Clinical Features==
 +
*Most common features: vomiting, AMS, poor feeding
 +
**May also see lethargy, apnea, sz
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
# Ingestions (e.g. ETOH)
+
*Ingestions (e.g. ETOH)
# Metabolic disease^
+
*Metabolic disease^
# [[Sepsis (peds)|Sepsis]]
+
*[[Sepsis (peds)|Sepsis]]
  
^Save blood tubes before treatment
+
==Diagnosis==
 +
*Blood glucose <45 in symptomatic neonate
 +
*Blood glucose <35 in asymptomatic neonate
  
== Diagnosis ==
+
===Work-Up===
*Glucose <45 in symptomatic neonate
+
*Blood glucose level
*Glucose <35 in asymptomatic neonate
 
*Most common features: vomiting, AMS, poor feeding
 
**May also see lethargy, apnea, sz
 
 
 
==Work-Up==
 
*Rapid glucose
 
 
*UA
 
*UA
 
**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
*Glucagon 0.3 mg/kg IM or IV
 
**If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency)
 
  
==Treatment==
+
==Management==
 
''See [[critical care quick reference]] for doses by weight
 
''See [[critical care quick reference]] for doses by weight
 
*Glucose
 
*Glucose
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*[[Glucagon]]
 
*[[Glucagon]]
 
**Used for persistent hypoglycemia despite glucose administration
 
**Used for persistent hypoglycemia despite glucose administration
**0.03 mg/kg subq/IV
+
**0.03 mg/kg IM/IV
  
 
{{Pediatric hypoglycemia chart}}
 
{{Pediatric hypoglycemia chart}}
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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
 
| 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
 
|}
 
|}
 +
 +
==Disposition==
 +
*
  
 
==See Also==
 
==See Also==
[[Hypoglycemia (Neonatal)]]
+
*[[Hypoglycemia]]
 +
*[[Neonatal hypoglycemia]]
  
[[Hypoglycemia]]
+
==References==
 +
<References/>
  
 
[[Category:Peds]]
 
[[Category:Peds]]
 
[[Category:Endo]]
 
[[Category:Endo]]

Revision as of 03:54, 11 August 2015

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

Clinical Features

  • Most common features: vomiting, AMS, poor feeding
    • May also see lethargy, apnea, sz

Differential Diagnosis

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

Diagnosis

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

Work-Up

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

Management

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 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
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

Disposition

See Also

References