HYPOGLYCAEMIA

Question 1

List of five main broad causes of hypoglycaemia in paediatrics and give an example of each

Answer 1

1. Endocrine: hyperinsulinism, hypopituitarism, congenital adrenal hyperplasia
2. Metabolic: glycogen storage disease, ketotic hypoglycaemia
3. Toxic: salicylate, insulin, alcohol
4. Hepatic: hepatitis, Reye syndrome
5. Systemic: starvation, sepsis, malabsorption

Question 2

What level of glucose is considered hypoglycaemia in a child over one month?

Answer 2

2.6 mmol/L

Question 3

Eight month old child presents with lethargy, sweating and tachycardia. You suspect hypoglycaemia, what will you do initially? Explain why

Answer 3

Take blood samples before correcting blood glucose: this is because certain pointers to cause of unexplained hypoglycaemia or detectable only during the episode

Question 4

What are the six main first line investigations before correcting glucose?

Answer 4

• Glucose
• Insulin
• Growth hormone
• C-peptide
• Cortisol
• Urinary ketones

Question 5

What is the monitoring needed in hypoglycaemic patients?

Answer 5

• Continuous pulse oximetry
• ECG monitoring
• Intermittent blood pressure monitoring

Question 6

What is the treatment for hypoglycaemia and the asymptomatic and symptomatic child?

Answer 6

• Asymptomatic: oral glucose drink or gel
• Symptomatic: glucose 10% 5 to 10 mL / kg or 25% 2 to 4 mL / kg IV. Followed by continuous infusion of 0.45% saline with 5 to 10% glucose

Question 7

If there is no response to increased glucose infusion in hypoglycaemia what is the next step?

Answer 7

Consider glucagon or hydrocortisone

These patients need advice from a specialist