Hypoglycaemia Flashcards

1
Q

Define hypoglycaemia in children

A

Blood glucose <2.6mmol/L in children who do not have Diabetes Mellitus
<4 with DM

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2
Q

What is the aetiology of hypoglycaemia

A

Insulin excess:
- Exogenous
- Hypoglycaemic hyperinsulinism of infancy (PHHI)
- Sulphonylurea use
- Autoimmune (insulin receptor Abs)
- Beckwith-Wiedemann syndrome
- skipping meals

Non-insulin driven
- Liver disease
- Ketotic hypoglycaemic of childhood
- Inborn errors of metabolism e.g. galactosaemia
- Endocrine e.g. Addison’s, CAH
- Sepsis
- Drugs e.g. alcohol, steroids, beta-blockers, ACEi

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3
Q

What are the risk factors for neonatal hypoglycaemia

A

Within the first 48hrs of life
Maternal DM or GDM (hyperplasia of pancreatic islet cells from exposure to elevated maternal gucose)
IUGR (poor glycogen stores)
Pre-term (poor glycogen stoor)
Large of dates
Hypothermic, polycythaemia, ill
Maternal beta-blocker use in the third trimester/time of delivery

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4
Q

What are the symptoms and signs of hypoglycaemia

A

Mild: sweating, palpitations, tremor, pallor, hunger, tingling lips, anxiety, irritability
Moderate: behavioural change, headache, drowsy, difficulty concentrating, Impaired vision, confusion, agitation
Severe: severe cognitive impairment, convulsions, LOC, coma

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5
Q

What are the signs of neonatal hypoglycaemia

A

Within 48hrs:
Jitteriness
Irritability
Apnoea
Lethargy, drowsiness
Seizures
Abnormal feeding behaviour (not waking for feeds, not sucking effectively, unsettled, demanding frequent feeds), especially after a period of feeding well

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6
Q

What are the signs of nocturnal hypoglycaemia

A

Fatigue
Headache
“hangover” feeling

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7
Q

What investigations should be done for hypoglycaemia

A

Bedside:
- BM: <4/3.5
- First urine: ?organic acids, toxicology
- Heel prick
Bloods:
- Blood glucose
- Insulin
- C-peptide
- GH
- Cortisol
- Ketones
- Blood gas
- Ammonia
- Amino acids

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8
Q

What is the management for hypoglycaemia in children

A
  1. A-E
  2. Able to swallow → 0.3/kg oral fast-acting carbohydrate/glucose (glucose/dextrose tablets, glucogel (40%))
  3. Re-assess after 10-15 minutes
  4. No improvement → repeat carb/glucose
  5. Reduced consciousness → IM glucagon ± IV glucose (<8yo = <500micrograms)
  6. No improvement → emergency hospital transfer → IV glucose (dextrose) 10%

Recurrent, severe → islet or pancreas transplant

Note: clinical symptoms and signs may lag behind improvement in blood glucose

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9
Q

What advice should be given regarding hypoglycaemia

A

Ensure all meals contain carbohydrate e.g. bread, potatoes, pasta
If there is no meal due and there are symptoms of hypoglycaemia, have a carbohydrate-containing snack e.g. sandwich, two plain biscuits, banana
How to recognise hypoglycaemic episodes:
Importance of self-monitoring of blood glucose levels

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10
Q

What is the management for nocturnal hypoglycaemia

A

Review the knowledge of blood glucose monitoring and diabetes self-management skills
Review their current insulin regimen, evening eating habits, and any changes to exercise/physical activity
Advise monitoring of blood glucose levels overnight (2-3am is when it is most likely)

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11
Q

What is the management for neonatal hypoglycaemia

A

2–2.6mmol/L: recheck level until satisfactory (at least 3 prefeed levels >2mmol/L)
<2mmol/L: give dextrose gel to the mouth and check level (after 30 mins)
<1.0 mmol/L or <2.0 mmol/L and clinical signs or has not responded adequately to two doses of glucose gel: IV dextrose (10%)

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12
Q

How is neonatal hypoglycaemia prevented

A

Early and frequent milk feeding
Feed asap after birth and as often as possible
Don’t allow >3 hours between feeds
Continue until effective feeding → glucose measurements >2 on 2x occasions
Skin-to-skin, keep baby warm
Don’t wait for baby to cry: early hunger signs include rapid eye movements, mouth and tongue movements, sucking on a fist
Feed as long as , or as much as baby wants

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13
Q

What are the complications and prognosis for hypoglycaemia

A

Developmental delay
Hypertonic IV glucose treatment → cerebral oedema

If untreated/severe, hypoglycaemia poses a high risk to infants who have high energy requirements and relatively poor reserves of glucose from glycogen, but require it for brain growth.

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