The Hypoglycemia Pediatric Patient

26 Jun

RAGING HYPOTHETICAL:

Your next patient is a 6 yo girl who presents with altered mental status. Bedside glucose is 12. Now what?

Causes of hypoglycemia in pediatric patients:

The differential is broad, but can be categorized into these main groups:

  • Disorders of carbohydrate metabolism, including
    • Disorders of glycogenolysis
    • Disorders of gluconeogenesis
    • Galactossemia
    • Hereditary Fructose intolerance
  • Disorders of Amino Acid Metabolism
  • Disorders of Fatty Acid Metabolism
  • Increased utilization of Insulin
    • Hyperinsulinism
    • Ingestion of oral anti-hyperglycemics
    • Error in calculating insulin doses when patient is a Type I diabetic
  • Miscellaneous causes
    • Ketotic hypoglycemia
    • Hormone deficiencies
      • Growth Hormone deficienct
      • Cortisol deficiency
    • Ingestions
      • Alcohol
      • Salicylates
      • Beta-blockers
      • Oral anti-hyperglycemics
    • Surgery
    • Sepsis

Treatment:

Recognizing the hypoglycemia is the first step. Many of the causes of hypoglycemia will only be determined after a detailed inpatient workup.

Our job is to rule out the treatable causes such as ingestion and sepsis and treat accordingly.

These patients will often require D10 or D25 infusions to maintain euglycemia.

Under stress conditions, children with adrenal insufficiency should receive Hydrocortisone in the following doses (these doses will sustain appropriate levels for 6 hours)

  • ❤ years: 25 mg
  • 3-12 years: 50 mg
  • >12 years: 100 mg

Submitted by W. Brooks.

Reference(s): UpToDate; Donohoue PA. Adrenal disorders. In: Pediatric Practice Endocrinology, Kappy MS, Allen DB, Geffner ME. (Eds), McGraw Hill Medical, New York 2010. p.132-190.; picture

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