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].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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