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Approach to hypoglycemia in infants and children

INTRODUCTION

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 glycogenolysis, glycogen synthesis, 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 blood glucose concentration, even when totally deprived of calories for weeks or, in the case of obese subjects, months [1]. 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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Literature review current through: Sep 2014. | This topic last updated: Sep 11, 2013.
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References
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  1. Cahill GF Jr, Herrera MG, Morgan AP, et al. Hormone-fuel interrelationships during fasting. J Clin Invest 1966; 45:1751.
  2. Chaussain JL, Georges P, Calzada L, Job JC. Glycemic response to 24-hour fast in normal children: III. Influence of age. J Pediatr 1977; 91:711.
  3. Haymond MW, Karl IE, Clarke WL, et al. Differences in circulating gluconeogenic substrates during short-term fasting in men, women, and children. Metabolism 1982; 31:33.
  4. Darmaun D, Haymond MW, Bier DM. Metabolic aspects of fuel homeostasis in the fetus and neonate. In: Endocrinology, 3rd ed, DeGroot LJ, Besser M, Burger HG, et al (Eds), WB Saunders, Philadelphia 1995. p.2258.
  5. Kalhan SC, D'Angelo LJ, Savin SM, Adam PA. Glucose production in pregnant women at term gestation. Sources of glucose for human fetus. J Clin Invest 1979; 63:388.
  6. Sunehag A, Ewald U, Gustafsson J. Extremely preterm infants (< 28 weeks) are capable of gluconeogenesis from glycerol on their first day of life. Pediatr Res 1996; 40:553.
  7. Grajwer LA, Sperling MA, Sack J, Fisher DA. Possible mechanisms and significance of the neonatal surge in glucagon secretion: studies in newborn lambs. Pediatr Res 1977; 11:833.
  8. Cornblath M, Schwartz R. Disorders of Carbohydrate Metabolism in Infancy, Blackwell Publications, Cambridge, MA 1991.
  9. Haymond MW, Sunehag A. Controlling the sugar bowl. Regulation of glucose homeostasis in children. Endocrinol Metab Clin North Am 1999; 28:663.
  10. Haymond MW, Howard C, Ben-Galim E, DeVivo DC. Effects of ketosis on glucose flux in children and adults. Am J Physiol 1983; 245:E373.
  11. Bier DM, Leake RD, Haymond MW, et al. Measurement of "true" glucose production rates in infancy and childhood with 6,6-dideuteroglucose. Diabetes 1977; 26:1016.
  12. Huopio H, Shyng SL, Otonkoski T, Nichols CG. K(ATP) channels and insulin secretion disorders. Am J Physiol Endocrinol Metab 2002; 283:E207.
  13. Amiel SA, Simonson DC, Sherwin RS, et al. Exaggerated epinephrine responses to hypoglycemia in normal and insulin-dependent diabetic children. J Pediatr 1987; 110:832.
  14. Cryer PE. Banting Lecture. Hypoglycemia: the limiting factor in the management of IDDM. Diabetes 1994; 43:1378.
  15. Collier A, Steedman DJ, Patrick AW, et al. Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an accident and emergency department. Diabetes Care 1987; 10:712.
  16. Wiethop BV, Cryer PE. Alanine and terbutaline in treatment of hypoglycemia in IDDM. Diabetes Care 1993; 16:1131.
  17. Haymond MW. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am 1989; 18:211.
  18. Verrotti A, Fusilli P, Pallotta R, et al. Hypoglycemia in childhood: a clinical approach. J Pediatr Endocrinol Metab 1998; 11 Suppl 1:147.
  19. Stanley CA, Lieu YK, Hsu BY, et al. Hyperinsulinism and hyperammonemia in infants with regulatory mutations of the glutamate dehydrogenase gene. N Engl J Med 1998; 338:1352.
  20. Roe TF, Kogut MD. Hypopituitarism and ketotic hypoglycemia. Am J Dis Child 1971; 121:296.
  21. Kershnar AK, Roe TF, Kogut MD. Adrenocorticotropic hormone unresponsiveness: report of a girl with excessive growth and review of 16 reported cases. J Pediatr 1972; 80:610.
  22. Green RP, Hollander AS, Thevis M, et al. Detection of surreptitious administration of analog insulin to an 8-week-old infant. Pediatrics 2010; 125:e1236.
  23. Clayton PT, Eaton S, Aynsley-Green A, et al. Hyperinsulinism in short-chain L-3-hydroxyacyl-CoA dehydrogenase deficiency reveals the importance of beta-oxidation in insulin secretion. J Clin Invest 2001; 108:457.
  24. Cornblath M, Pildes RS, Schwartz R. Hypoglycemia in infancy and childhood. J Pediatr 1973; 83:692.