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 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 . 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
- Autonomic response
- IMMEDIATE MANAGEMENT
- Critical samples
- - Blood
- - Urine
- Clinical management
- - Glucose therapy
- Oral therapy
- Intravenous therapy
- - Glucagon
- - Monitoring
- DIAGNOSTIC EVALUATION
- - Past medical history
- - Age at onset
- - Dietary factors
- - Family history
- Physical examination
- Elective fast
- Glucagon challenge
- Additional testing
- INTERPRETATION OF RESULTS
- Inappropriate ketosis
- Appropriate ketosis
- SUMMARY AND RECOMMENDATIONS