Hypoglycaemia in Children
Description Diagnostic criteria Medicine treatment Referral ICD-10 Code: E16.2 DESCRIPTION Infants and small children have relatively limited glycogen stores with larger brain/body ratios than adults and are, therefore, at greater risk of hypoglycaemia during starvation. The causes of hypoglycaemia (outside the neonatal period) include: hypopituitarism, adrenal insufficiency, growth hormone defic
ICD-10 Code: E16.2
DESCRIPTION
Infants and small children have relatively limited glycogen stores with larger brain/body ratios than adults and are, therefore, at greater risk of hypoglycaemia during starvation.
The causes of hypoglycaemia (outside the neonatal period) include:
- hypopituitarism,
- adrenal insufficiency,
- growth hormone deficiency,
- hypothyroidism,
- hyper-insulinaemia,
- inborn errors of metabolism,
- malnutrition,
- sepsis,
- liver dysfunction,
- malaria,
- severe illness with poor intake,
- accelerated starvation (ketotic hypoglycaemia),
- medicine, e.g. insulin, alcohol, aspirin, beta-blockers, oral hypoglycaemic agents, quinine.
DIAGNOSTIC CRITERIA
Clinical
- Acute autonomic symptoms: hunger, nausea, anxiety, pallor, palpitations, sweating, trembling.
- Neuroglycopaenic symptoms: impaired thinking, change of mood, irritability, dizziness, headache, tiredness, confusion, and later, convulsions and coma.
- Patients are often asymptomatic, especially younger children, who may be completely asymptomatic or present only with a behaviour change.
Investigations
- Serum glucose concentration < 2.6 mmol/L.
- Hypoglycaemia is a clinical emergency requiring prompt therapy. However, if possible, draw a blood sample for investigation prior to the administration of glucose. Collect 5 mL of blood in a plain tube at –20°C. Such samples may provide clear biochemical evidence of the cause of the hypoglycaemic episode thus avoiding having to subject the child to further investigations.
MEDICINE TREATMENT
After collection of initial blood samples:
- Dextrose 10%, IV, 2–5 mL/kg.
- Dilute dextrose 50% solution before use to 10% strength.
(1 mL/kg of dextrose 50% plus 4 mL/kg of water for injection, gives 10% dextrose solution).
- Dilute dextrose 50% solution before use to 10% strength.
Stabilisation
- Sodium chloride 0.9%/dextrose 5%.
- Increasing the dextrose concentration in the fluid to 7.5% or 10% may be necessary:
- To increase from 5% to 10% dextrose concentration in 1 L of fluid, add 100 mL 50% dextrose water.
- 10 mL 50% DW increases dextrose concentration of 100 mL of fluid by 5%.
For persistent hypoglycaemia consider the underlying cause, e.g. hyper-insulinism or adrenal insufficiency (see: Adrenal insufficiency, acute.). For persistent hypoglycaemia in the neonate, see: Prematurity and Neonatal Conditions. An inappropriately high insulin or C-peptide level at the time of the confirmed hypoglycaemia is also strongly suggestive of hyper-insulinism.
If hyper-insulinism is suspected, administer:
- Glucagon, IM/SC.
- If < 12 years of age: 0.5 mg.
- If > 12 years of age: 1.0 mg.
OR
- Diazoxide, orally, 5 mg/kg/day in three divided doses, may increase to 15 mg/kg/day.
Ongoing treatment
Intravenous fluid therapy as needed.
Start oral feeds as soon as possible.
REFERRAL
- All patients with confirmed hypoglycaemia not explained by intercurrent illness or drugs.
- All neonates with persisting or recurrent hypoglycaemia.
- Suspected hyper-insulinism.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 7: Endocrine, 7.6 Hypoglycaemia In Children