Hypoglycaemia

Question 1

What is hypoglycaemia?

Answer 1

BM <2.6mmol/L

Question 2

What are clinical features of hypoglycaemia?

Answer 2

Sweating 
Pallor
CNS signs:
Irritability
Headache
Seizures
Coma

Question 3

When should BM be checked?

Answer 3

Child who:
Becomes septic or appears seriously ill ABD the DEFG
Has prolonged seizure
Develops altered state of consciousness

Question 4

What investigations?

Answer 4

Blood glucose - confirm
Growth hormone, Cortisol, insulin, C-peptide - measure of person’s own insulin secretion even if exogenous insulin is given, fatty acids

Question 5

What are causes of hypoglycaemia?

Answer 5

Insulin excess:
Excess exogenous insulin
Beta-cell tumours, insulinoma
Drug induced - sulphonyurea)
Autoimmune - insulin receptor antibodies

Without hyperinsulinaemia:
Liver disease
Ketotic hypoglycaemia
Glycogen storage disorders
Hormonal deficiency Reduced GH, ACTH, Addison's
CAH

Question 6

What is management of mild/moderatehypoglycaemia?

Answer 6

Oral glucose (tablets or sugary drink)
IF unable to eat give oral glucose gel
10-15g of quick acting snack carbohydrate e.g. 200ml OJ

Question 7

What is magnet of severe hypoglycaemia?

Answer 7

IVI 10% glucose 5ml/kg
Avoid giving an excess volume as IV soon is hypertonic and could cause cerebraleodema

Expect quick return to consciousness

Recheck glucose
If still low, give IV dexamethasone

Once BM > 4mmol/L and patient has recovered give long-acting carbohydrate - slice of toast)