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

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==DDX==
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''This page is for <u>non-neonatal pediatric</u> hypoglycemia. See [[hypoglycemia]] for adult patients or [[neonatal hypoglycemia]].''
# Ingestions (e.g. ETOH)
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==Background==
# Metabolic dz^
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===Etiology===
# Sepsis
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*Inadequate oral intake
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*Excess insulin
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**Newborns of [[DM|diabetic mothers]]
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*Deficient hyperglycemic hormones (growth or [[CAH|adrenal hormone deficiency]])
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*[[Inborn errors of metabolism]]: fatty acid oxidation or carbohydrate metabolism disorders
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*Prematurity (inadequate glycogen stores)
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*[[Sepsis (peds)|Sepsis]]
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*[[ETOH]] exposure (children have low glycogen stores)
  
^Save blood tubes b/f treatment
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==Clinical Features==
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*Most common features:
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**[[nausea and vomiting (peds)|Vomiting]]
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**[[altered mental status (peds)|Altered mental status]]
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**[[failure to thrive (peds)|Poor feeding]]
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**May also see lethargy, apnea, [[seizure (peds)|seizure]]
  
==Treatment==
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==Differential Diagnosis==
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====Systemic Illness====
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*Critical Illness
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**[[Sepsis (peds)|Sepsis]]
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*Organ Failure
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**[[Hepatic failure]]
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**[[Renal failure]]
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*Endocrinopathy
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**[[Adrenal insufficiency]], [[congenital adrenal hyperplasia]]
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*[[Seizure (peds)|Seizure]]
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*[[Inborn errors of metabolism]]
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====Drugs====
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*Anti-hyperglycemic
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**[[Insulin]]
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**Oral secretagogue
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***[[Sulfonylurea toxicity]]
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*Other
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**[[EtOH]]
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**[[B-blocker]]
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**[[ACE inhibitor|ACEI]]
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**[[Acetaminophen Overdose|Acetaminophen (OD)]]
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====Malignancy====
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*Insulinoma
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*Non-islet cell
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*Insulin/receptor autoantibodies
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*High tumor burden
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====Other====
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*Artifactual
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**Specimen collection
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**Consumption
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***[[Leukemia (peds)|Leukemia]]
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***Erythrocytosis
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***[[hemolytic anemia|Hemolytic disease]]
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*Starvation
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**[[Anorexia nervosa]]
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====Precipitants of anti-hyperglycemic induced hypoglycemia====
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*Decreased glucose
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**Missed meal
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**Consumption (exercise, illness)
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*Increased drug
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**Error (patient, provider)
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**Intentional overdose
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**Increased availability
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***[[Hepatic failure]]
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***[[Renal failure]]
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***Drug interaction
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==Evaluation==
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===Work-Up===
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*Blood glucose level
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*[[Urinalysis]]
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**If ketones: adrenal or GH deficiency, inborn errors of metabolism
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**If no ketones: Hyperinsulinemia, fatty acid oxidation defects
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===Diagnosis===
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*Blood glucose <45 in symptomatic neonate
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*Blood glucose <35 in asymptomatic neonate
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==Management==
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''See [[critical care quick reference]] for doses by weight
 
*Glucose
 
*Glucose
**Bolus D10W 2mL/kg; then infuse D10W @ 0.06-0.08mL/kg/min
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**Bolus [[D10W]] 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
*Glucagon
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*[[Glucagon]]
 
**Used for persistent hypoglycemia despite glucose administration
 
**Used for persistent hypoglycemia despite glucose administration
**0.03 mg/kg subq/IV
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**Will not work with etoh exposure as glycogen stores are already low
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**0.03mg/kg IM/IV
  
{| class="pbNotSortable" width="200" cellspacing="1" cellpadding="1" border="1"
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{{Pediatric hypoglycemia chart}}
| Age
 
| Tx
 
| Def
 
|-
 
| <2mo
 
| D10W
 
| (glu <40)
 
|-
 
| 2mo-8yrs
 
| D25W
 
| (glu <60)
 
|-
 
| >8yrs
 
| D50W
 
| (glu <70)
 
|}
 
Dose all = 2mL/kg IV  (may use 4mL/kg for D10W) or use the Rule of 50 (5cc/kg for D10, 2cc/kg for D25, 1cc/kg for D50)
 
  
^recheck in all Q5min and repeat dose if low
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==Disposition==
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*
  
 
==See Also==
 
==See Also==
[[Hypoglycemia (Neonatal)]]
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*[[Hypoglycemia]]
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*[[Neonatal hypoglycemia]]
  
[[Hypoglycemia]]
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==References==
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<References/>
  
[[Category:Peds]]
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[[Category:Pediatrics]]
[[Category:Endo]]
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[[Category:Endocrinology]]
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[[Category:FEN]]

Latest revision as of 19:08, 6 October 2019

This page is for non-neonatal pediatric hypoglycemia. See hypoglycemia for adult patients or neonatal hypoglycemia.

Background

Etiology

Clinical Features

Differential Diagnosis

Systemic Illness

Drugs

Malignancy

  • Insulinoma
  • Non-islet cell
  • Insulin/receptor autoantibodies
  • High tumor burden

Other

Precipitants of anti-hyperglycemic induced hypoglycemia

  • Decreased glucose
    • Missed meal
    • Consumption (exercise, illness)
  • Increased drug

Evaluation

Work-Up

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

Diagnosis

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

Management

See critical care quick reference for doses by weight

  • Glucose
    • Bolus D10W 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
  • Glucagon
    • Used for persistent hypoglycemia despite glucose administration
    • Will not work with etoh exposure as glycogen stores are already low
    • 0.03mg/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

Disposition

See Also

References