Ver el código de «Non-neonatal hypoglycemia (peds)»

''This page is for <u>non-neonatal pediatric</u> hypoglycemia. See [[hypoglycemia]] for adult patients or [[neonatal hypoglycemia]].''
==Background==
===Etiology===
*Inadequate oral intake
*Excess insulin
**Newborns of [[DM|diabetic mothers]]
*Deficient hyperglycemic hormones (growth or [[CAH|adrenal hormone deficiency]])
*[[Inborn errors of metabolism]]: fatty acid oxidation or carbohydrate metabolism disorders
*Prematurity (inadequate glycogen stores)
*[[Sepsis (peds)|Sepsis]]
*[[ETOH]] exposure (children have low glycogen stores)

==Clinical Features==
*Most common features: <ref>Thornton PS, et al. Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. J Pediatr. 2015;167(2):238-245. PMID 25957977</ref>
**[[nausea and vomiting (peds)|Vomiting]]
**[[altered mental status (peds)|Altered mental status]]
**[[failure to thrive (peds)|Poor feeding]]
**May also see lethargy, apnea, [[seizure (peds)|seizure]]

==Differential Diagnosis==
====Systemic Illness====
*Critical Illness
**[[Sepsis (peds)|Sepsis]]
*Organ Failure
**[[Hepatic failure]]
**[[Renal failure]]
*Endocrinopathy
**[[Adrenal insufficiency]], [[congenital adrenal hyperplasia]]
*[[Seizure (peds)|Seizure]]
*[[Inborn errors of metabolism]]

====Drugs====
*Anti-hyperglycemic
**[[Insulin]]
**Oral secretagogue
***[[Sulfonylurea toxicity]]
*Other
**[[EtOH]]
**[[B-blocker]]
**[[ACE inhibitor|ACEI]]
**[[Acetaminophen Overdose|Acetaminophen (OD)]]

====Malignancy====
*Insulinoma
*Non-islet cell
*Insulin/receptor autoantibodies
*High tumor burden
====Other====
*Artifactual
**Specimen collection
**Consumption
***[[Leukemia (peds)|Leukemia]]
***Erythrocytosis
***[[hemolytic anemia|Hemolytic disease]]
*Starvation
**[[Anorexia nervosa]]

====Precipitants of anti-hyperglycemic induced hypoglycemia====
*Decreased glucose
**Missed meal
**Consumption (exercise, illness)
*Increased drug
**Error (patient, provider)
**Intentional overdose
**Increased availability
***[[Hepatic failure]]
***[[Renal failure]]
***Drug interaction

==Evaluation==
===Work-Up===
*Blood glucose level
*[[Urinalysis]]
**If ketones: adrenal or GH deficiency, inborn errors of metabolism
**If no ketones: Hyperinsulinemia, fatty acid oxidation defects

===Diagnosis===
*Blood glucose <45 in symptomatic neonate
*Blood glucose <35 in asymptomatic neonate

==Management==
''See [[critical care quick reference]] for doses by weight
*Glucose
**Bolus [[D10W]] 2mL/kg; then infuse D10W at 0.06-0.08mL/kg/min
*[[Glucagon]]
**Used for persistent hypoglycemia despite glucose administration
**Will not work with etoh exposure as glycogen stores are already low
**0.03mg/kg IM/IV

{{Pediatric hypoglycemia chart}}

==Disposition==
*

==See Also==
*[[Hypoglycemia]]
*[[Neonatal hypoglycemia]]

==References==
<References/>

[[Category:Pediatrics]]
[[Category:Endocrinology]]
[[Category:FEN]]