Hypoglycaemia

Hypoglycaemia

common in neonates during 1st few days of life
1. after this rare in non-diabetics
definition
1. plasma glucose < 2.6 mmol/L
clinical features
1. sweating
2. pallor
3. CNS signs
  1. irritability
  2. headache
  3. seizures
  4. coma
4. if hyperglycaemia persists
  1. neurological sequelae may be permanent
    1. epilepsy
    2. severe learning difficulties
    3. microcephaly
    4. risk greatest in early childhood
      1. period of most rapid brain growth
INFANTS ARE AT HIGH RISK
1. they've high energy requirements
  1. but poor glucose reserves from glycogenesis & gluconeogenesis
2. w/ fasting
  1. so never starve infants for > 4hrs
    1. even for pre-op
Ix
1. must check blood glucose in any child who
  1. becomes septicaemic or looks v ill
  2. has a prolonged seizure
  3. develops an altered state of consciousness
  4. bedside testing
    1. glucose-senstive strips and meter
      1. NB: strips only tell you that glucose is in a low range
        need confirmatory lab measurement
  5. lab testing
    1. if cause of hypoglycaemia unknown
      1. collect blood at time of hypoglycaemia
      2. send 1st available urine
Causes
1. beyond immediate neonatal period
  1. fasting
    1. insulin excess
      1. excess exogenous insulin
        diabetes mellitus
        insulin given clandestinely
      2. 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
      3. drug-induced
        sulphonylurea
      4. autoimmune
        insulin receptor antibodies
      5. Beckwith syndrome
    2. w/o hyperinsulinaemia
      1. liver disease
      2. 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
      3. inborn errors of metabolism
        glycogen storage disorders
        hepatomegaly
        profound hypoglycaemia
      4. hormonal def
        growth hormone
        ACTH
        Addison disease
        congenital adrenal hyperplasia
  2. reactive/non-fasting
    1. galactosaemia
    2. leucine sensitivity
    3. fructose intolerance
    4. maternal diabetes
    5. hormonal def
    6. aspirin/alcohol poisoning
2. neonatal period
  1. transient neonatal hypoglycaemia
    1. exposure to high levels of insulin in utero
      1. diabetic or glucose intolerant mum
Rx
1. 2 ml/kg of 10% dextrose followed by 10% dextrose infusion
  1. be careful not to give excess vol
    1. solution is hypertonic & could -> cerebral oedema
  2. if delay in establishing infusion or failure to respond
    1. im glucagon (0.5-1 mg)
      1. in neonate low sugar v likely to be secondary to hyperinsulinism
2. corticosteroids
  1. if hypopituitarism or hypoadrenalism possible
3. lab measurements of glucose to ensure correction

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	Created by v.djabatey over 10 years ago