Hypoglycemia in Pediatric Emergency

There should be a low threshold for performing a Dextrostix test in the acutely unwell child in the Emergency Department. Beyond the neonatal period, hypoglycemia is defined as a blood glucose less than 2.5 mmol/liter. In children who have had a seizure, hypoglycemia can be the cause of the seizure, or the result of a prolonged seizure.

Effects of hypoglycemia

The effects of the hypoglycemia itself, from whatever cause, are mainly effects on the central nervous system and those of adrenergic overdrive as Table below. Other clinical signs will depend on the cause of the hypoglycemia and a thorough clinical examination is required, including height and weight. 

Hypoglycemia Effects in pediatric

Investigation

Blood and urine must be taken off for metabolic investigation as soon as the child presents, before treatment is commenced. Investigations are listed in Box A.

Note that:

• Hyperinsulinism is the commonest cause of hypoglycemia in children under 2 years old, This diagnosis is excluded by ketonuria.

• ‘Accelerated starvation’ (idiopathic ketotic hypoglycemia) is the commonest cause of hypoglycemia after the age of 2 years, but may present earlier. The diagnosis can be established when fasting-induced hypoglycemia is accompanied by elevated urinary ketones, in the absence of other pathology. It is treated by frequent high protein and carbohydrate meals.

Management

Symptomatic hypoglycemia should be treated with an i.v. bolus of 5 ml/kg weight of 10% dextrose (0.25–0.5 mg/kg weight). The expected maintenance infusion rate is 3–5 ml/kg weight per hour of 10% dextrose (6–8 mg/kg weight per minut). A required infusion rate of 10–20 mg/kg weight per minute is consistent with hyper-insulinism.