hypoglyemcia Flashcards
(10 cards)
Key points - hypoglycemia
Hypoglycaemia is a Blood Glucose Level (BGL) low enough to cause signs and/or symptoms of impaired brain function and neurogenic response - generally BGL <3.3 mmol/L
Infants with BGL <2.6 mmol/L and risk factors are at risk of acute and long-term neurological sequelae.
Altered conscious state or seizures warrant prompt BGL assessment and management with a bolus of IV 10% Dextrose (2 mL/kg) or IM glucagon.
A venous blood gas and other diagnostic blood tests are important to identify an underlying cause but should not delay management.
What BGL in neonates warrants intervention
<2.6
Causes of hypoglyemia peads
Neonate < 48-72 hrs
Prem, IUGR, perinatal asphyxia, hypothermia, sepsis, resp distress, diabetic mother, macrosomia, syndrome (eg Beckwith-Wiedemann), pancreatic dysfunction
Neonate – 2yrs
Congenital hyperinsulinism (most common cause of persistent hypoglycaemia <2 yrs), inborn errors of metabolism, congenital hormone deficiencies (eg growth hormone deficiency)
Child
Accelerated starvation (previously known as “ketotic hypoglycaemia”)**, hypopituitarism, growth hormone deficiency
Adolescent
Insulinoma, adrenal insufficiency, eating disorder
All ages
Complication associated with Type 1 Diabetes Mellitus (see Diabetes Mellitus), other illness (eg sepsis, congenital heart disease, tumour, adrenal insufficiency)
Red flag features hypoglyecmia
Anxiety, sweating, lethargy, irritability, uncharacteristic behaviour, hypothermia, confusion, coma, seizures
Neonate <48 hrs - apnoea, hypotonia, jitteriness, poor feeding, high pitched cry
Clin f and hx - hypoglyecmia
Symptoms of hypoglycaemia
Palpitations, tremor, anxiety, sweating, hunger, paraesthesia
Severe hypoglycaemia - lethargy, irritability, uncharacteristic behaviour, hypothermia, confusion, coma, seizures
Neonate <48 hrs - apnoea, hypotonia, jitteriness, poor feeding, high pitched cry
Dietary history, fasting/illness and relationship to food
Milk products (galactosaemia)
Fructose eg juices (hereditary fructose intolerance)
Protein (amino acid or organic acid disorders)
History of toxin ingestion – in toddlers or young children consider accidental ingestion of alcohol, oral hypoglycaemic agents (sulfonylureas), aspirin, beta blockers, or toxins
Increased glucose requirements, eg sepsis, shock, tumours, trauma
Past history
Neonatal history of hypoglycaemia
Episodes suggestive of hypoglycaemia eg undiagnosed seizure disorder
Previous gastric surgery, fundoplication (postprandial hypoglycaemia)
Family history
Consanguinity
Unexplained infant deaths (inborn errors of metabolism)
Hormonal deficiencies and hyperinsulinism
Examination findings - hypoglyemcia (peads)
Altered conscious state and seizures
Fever or hypothermia
Finding related to underlying diagnosis
Hepatomegaly and/or hypotonia (inborn error of metabolism)
Poor growth and nutrition
Dysmorphic (syndrome)
ix for suspected hypoglycemia (peads)
VBG
Diagnostic blood tests during the period of hypoglycemia (at presentation or an elective fast)- plasma glucose, Insulin & Cpeptide, cortisol, electrolytes, ketones, lactate, carnitine/acylcarnitine, LTS, Free fatty acids, ammonia, amino acids, growth hormone
Minimum blood volume required= 5ml
Tubes Required:
3 x 0.5 mL fluoride oxalate
3 x 0.5 mL lithium heparin
2 x 0.5 mL serum gel tube
Newborn Screening Test (Guthrie) card - send air dried and in envelope, not in a plastic specimen bag
All tests must go immediately to the laboratory on an ice pillow
Urine - first voided urine after hypoglycaemic episode, requesting glucose, ketones, reducing substances and amino and organic acids
mng peads hypoglycemia
https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/Hypoglycaemia-flow-charts-1-19-11-19.jpg
The aim of treatment is to return BGL to within the normal range (>3.9 mmol/L) through normal nutritional intake. See flow chart
Severe symptomatic hypoglycaemia should be corrected with an IV 10% dextrose bolus 2 mL/kg or IM glucagon (Neonate: glucagon 0.03-0.1 mg/kg, <25 kg give ½ vial (0.5 Units), <25 kg give ½ vial (0.5 Units), >25 kg give full vial (1.0 Units))
BGL should return to the normal range within 10-15 mins and remain so for 1 hour. Ideally, the child should start to feed and BGL should be rechecked within 30 mins
Persistent hypoglycaemia - consider consultation with Endocrinology and/or Metabolic specialist
When to consult with peads in hypoglyememia
Child is not responding to first line treatment of food, IV 10 % Dextrose bolus or IM glucagon
Neonates
D/C requirements for paediatric hypoglyemcia
A cause for hypoglycaemia must be known (or accelerated starvation assumed) prior to discharge
Neonates: BGL ≥2.6 for 3 consecutive normal feeds
Infants and older children: BGL >3 mmol/L at least 4 hours post feeds/meals
Accelerated starvation – parental education regarding prolonged starvation
