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

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Revision as of 14:01, 22 March 2016

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