The hypoglycaemic child
| Headline | |
|---|---|
| History | ➥ last food and drink ➥ poisoning e.g. alcohol, beta-blocker ➥ neonatal history ➥ growth + development ➥ history of miscarriage/SIDS |
| Examination | RR, fetor, hepatomegaly, weakness |
| Diagnostic investigations | - true blood glucose, LFT, VBG - bedside ketones Consider: - beta-hydroxybutyrate, free fatty acids, carnitine - insulin, C-peptide, amino acids - cortisol, ACTH, growth hormone - ammonia, lactate, pyruvate - alcohol, tox screen |
| Differentials | IEM... |
| Immediate management | ➥ 2-5ml/kg 10% glucose ➥ Check CBG after 5 mins ➥ Start glucose infusion 5mg/kg/min if not normalised ➥ Glucogel, glucagon (may not work with glycogen storage disorders) |
| Ongoing management |
Neonatal hypoglycaemia
| Definition: glucose <2 mmol/L | |
|---|---|
| History | Risk factors: Prematurity, IUGR, cold stress, asphyxia, sepsis |
| Examination | Jitteriness, afebrile seizure |
| Diagnostic investigations | finger-prick glucose <2.6mmol/L; temperature, exclude poisoning |
| Differentials | |
| Immediate management | Feed then repeat CBG until >3 If ↓ consciousness etc: ➥ 2ml/kg 10% dextrose IV + 10% dextrose maintenance dose ➥ repeat sugar 10 min after bolus |
| Ongoing management |
Hypoglycaemic screen
- true blood glucose, LFT, VBG
- bedside ketones
- beta-hydroxybutyrate, free fatty acids, carnitine
- insulin, C-peptide, amino acids
- cortisol, ACTH, growth hormone
- ammonia, lactate, pyruvate
- alcohol, tox screen