Approach to hypoglycemia in infants and children
- Agneta Sunehag, MD, PhD
Agneta Sunehag, MD, PhD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Morey W Haymond, MD
Morey W Haymond, MD
- Professor of Pediatric Nutrition
- Baylor College of Medicine
In healthy individuals, maintenance of a normal plasma glucose concentration depends upon:
●A normal endocrine system for integrating and modulating substrate mobilization, interconversion, and utilization.
●Functionally intact enzymes for glycogen synthesis, glycogenolysis, glycolysis, gluconeogenesis, and utilization of other metabolic fuels for oxidation and storage.
●An adequate supply of endogenous fat, glycogen, and potential gluconeogenic substrates (eg, amino acids, glycerol, and lactate).
Adults are capable of maintaining a near-normal plasma glucose concentration, even when fasting for weeks or, in the case of obese subjects, months . In contrast, healthy neonates and young children are unable to maintain normal plasma glucose concentrations after even a short fast (24 to 36 hours) and exhibit a progressive decline in plasma glucose concentration to hypoglycemic values [2,3].
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- GLUCOSE HOMEOSTASIS IN NORMAL INFANTS AND CHILDREN
- DEFINITION OF HYPOGLYCEMIA
- ETIOLOGY OF HYPOGLYCEMIA
- CLINICAL FEATURES
- Children and adults
- - Neurogenic (autonomic) symptoms
- - Neuroglycopenic symptoms
- IMMEDIATE MANAGEMENT
- Critical samples
- - Blood
- - Urine
- - Glucose therapy
- Conscious patient
- Patient with altered consciousness
- - Glucagon
- - Monitoring
- EVALUATION FOR THE CAUSE OF HYPOGLYCEMIA
- - Age at onset
- - Triggers
- - Past medical history
- - Family history
- Physical examination
- Laboratory testing
- Subsequent testing for unexplained hypoglycemia
- - Elective fast
- - Glucagon stimulation test
- - Interpretation of results
- Fatty acid oxidation disorders
- Defects in gluconeogenesis or glycogen metabolism
- Additional testing
- SUMMARY AND RECOMMENDATIONS
- Clinical presentation and diagnosis
- Evaluation for the cause