Hypoglycemia, general differential

• serum glucose levels decrease after birth for first 1-3 hours, then return to normal spontaneously, often asymtpomatic
• ketotic hypoglycemia
  • most common form of childhood hypoglycemia
  • usually occurs at 18 months to 5 years of age
  • hypoglycemia occurs during intercurrent illness when food intake is limited, then get ketotic and appropriately low insulin levels - usually remits by age 8-9 years
• hyperinsulinism (non-ketotic since insulin acutely inhibits ketogenesis)
  • detailed discussion: Hyperinsulinemia
  • children with diabetes on insulin
  • infants of diabetic mothers
  • Beckwith-Wiedemann
  • nesidioblastosis/insulinoma
  • panhypopituitarism
  • erythroblastosis fetalis
  • familial hyperinsulinemic hypoglycemia: autosomal recessive, unresponsive to medical tx
• intrauterine malnutrition (neonate)
  • IUGR
  • Prematurity
  • Smaller discordant twin
  • Polycythemia
  • Infants of toxemic mothers
  • Placental abnormalities
• Increased metabolic needs (neonate)
  • very premature
  • Severely ill infant
  • RDS
  • Perinatal asphyxia
  • Polycythemia
  • Hypothermia
  • CHF
  • Cyanotic congenital heart disease
• genetic disorders
  • glycogen storage diseases
  • galactosemia
  • disorders of gluconeogenesis
    • fructose-1,6-diphosphatase deficiency
    • phosphoenolpyruvate carboxykinase deficiency
  • amino acid disorders
    • methylmalonic acidemia
    • 3-hydroxy, 3-methylglutaric acidemia
    • ethylmalonic-adipic aciduria
    • glutaric acidemia type II
    • maple urine syrup disease
  • disorders of fatty acid metabolism
    • carnitine deficiency
    • acyl CoA dehydrogenase defects
    • factitious
  • LCAD
• hypopituitarism with growth hormone deficiency
• fructose intolerance
• Hypoglycemia: drugs causing
• factitious

Treatment of hypoglycemia (infant dosing)

• If pt symptomatic: 2cc/kg D10 bolus
• If seizing: 4cc/kg D10 bolus
• If asymptomatic: infusion of 8mg/kg/min dextrose
• Hyperinsulinism: Diazoxide +/-Octreotide
   

CHLA Board Review 2005 (Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics 16th ed. WB Saunders, Philadelphia 2000.)