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470775
Hypoglycaemia
Descripción
(Endocrine & metabolic) Paediatrics Mapa Mental sobre Hypoglycaemia, creado por v.djabatey el 08/01/2014.
Sin etiquetas
endocrine & metabolic
paediatrics
paediatrics
endocrine & metabolic
Mapa Mental por
v.djabatey
, actualizado hace más de 1 año
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Creado por
v.djabatey
hace más de 10 años
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Resumen del Recurso
Hypoglycaemia
common in neonates during 1st few days of life
after this rare in non-diabetics
definition
plasma glucose < 2.6 mmol/L
clinical features
sweating
pallor
CNS signs
irritability
headache
seizures
coma
if hyperglycaemia persists
neurological sequelae may be permanent
epilepsy
severe learning difficulties
microcephaly
risk greatest in early childhood
period of most rapid brain growth
INFANTS ARE AT HIGH RISK
they've high energy requirements
but poor glucose reserves from glycogenesis & gluconeogenesis
w/ fasting
so never starve infants for > 4hrs
even for pre-op
Ix
must check blood glucose in any child who
becomes septicaemic or looks v ill
has a prolonged seizure
develops an altered state of consciousness
bedside testing
glucose-senstive strips and meter
NB: strips only tell you that glucose is in a low range
need confirmatory lab measurement
lab testing
if cause of hypoglycaemia unknown
collect blood at time of hypoglycaemia
send 1st available urine
Causes
beyond immediate neonatal period
fasting
insulin excess
excess exogenous insulin
diabetes mellitus
insulin given clandestinely
beta-cell tumours/disorders
insulinoma
persistent hypoglycaemic hyperinsulinism of infancy (PHHI)
causes recurrent, severe neonatal hypoglycaemia
rare
gene mutations of pathways ->
dysregulation of insulin release by pancreatic islet cells->
profound non-ketotic hypoglycaemia
Rx
high [dextrose] sol and diazoxide
to main safe blood sugar levels pending ix
total pancreatectomy
risk of diabetes and exocrine pancreatic insufficiency
drug-induced
sulphonylurea
autoimmune
insulin receptor antibodies
Beckwith syndrome
w/o hyperinsulinaemia
liver disease
ketotic hypoglycaemia of childhood
young children readily get hypoglycaemic ff short period of starvation
due to limited reserves for gluconeogenesis
short, thin child
w/ low insulin levels
Mx
regular snacks & extra glucose drinks when ill
resolves spontaneously in later life
inborn errors of metabolism
glycogen storage disorders
hepatomegaly
profound hypoglycaemia
hormonal def
growth hormone
ACTH
Addison disease
congenital adrenal hyperplasia
reactive/non-fasting
galactosaemia
leucine sensitivity
fructose intolerance
maternal diabetes
hormonal def
aspirin/alcohol poisoning
neonatal period
transient neonatal hypoglycaemia
exposure to high levels of insulin in utero
diabetic or glucose intolerant mum
Rx
2 ml/kg of 10% dextrose followed by 10% dextrose infusion
be careful not to give excess vol
solution is hypertonic & could -> cerebral oedema
if delay in establishing infusion or failure to respond
im glucagon (0.5-1 mg)
in neonate low sugar v likely to be secondary to hyperinsulinism
corticosteroids
if hypopituitarism or hypoadrenalism possible
lab measurements of glucose to ensure correction
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