Non-neonatal hypoglycemia (peds): Difference between revisions
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==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 | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
# Ingestions (e.g. ETOH) | # Ingestions (e.g. ETOH) | ||
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^Save blood tubes before treatment | ^Save blood tubes before treatment | ||
=== Diagnosis === | === Diagnosis === | ||
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*Most common features: vomiting, AMS, poor feeding | *Most common features: vomiting, AMS, poor feeding | ||
**May also see lethargy, apnea, sz | **May also see lethargy, apnea, sz | ||
===Work-Up=== | ===Work-Up=== | ||
*Rapid glucose | *Rapid glucose | ||
*UA | *UA | ||
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**If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency) | **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 chart}} | |||
{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 621px; height: 444px;" | {| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 621px; height: 444px;" | ||
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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 | ||
|} | |} | ||
==See Also== | |||
[[Hypoglycemia (Neonatal)]] | |||
[[Hypoglycemia]] | |||
[[Category:Peds]] | |||
[[Category:Endo]] | |||
Revision as of 07:46, 1 May 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
Differential Diagnosis
- Ingestions (e.g. ETOH)
- Metabolic disease^
- 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:
|
| 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
| 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 |