Definition
• Glucose <50 in children; glucose <40 w/ age 3–24 h; glucose <45 in infants >24 h of age
Approach to the Patient
History
• Irritability, sweating, jitteriness, feeding problems, lethargy, cyanosis, tachypnea, &/or hypothermia. May be a/w sepsis, congenital heart dz, ventricular hemorrhage, tox, & respiratory distress syndrome, PMH/meds (see chart).
Physical Exam
• Hypotonia, lethargy, cyanotic, hypothermic, apneic, tachycardic, pallor, vomiting, tremulousness, ataxia, sz, diplopia, signs of CVA
Evaluation
• Labs: FSG, Chem 7, LFTs, serum insulin, UA (ketones), C-peptide (low in exogenous insulin, high in insulinoma or sulfonylureas); growth hormone, cortisol, glucagon levels; tox screen if indicated
Treatment
• Glucose replacement
• PO: Glucose paste, fruit juice (preferred)
• Infants: IV bolus: 10% dextrose: 2 mL/kg followed by infusion at 6–9 mg/kg/min
• Children: IV bolus: 10% dextrose at 5 mL/kg followed by infusion at 6–9 mg/kg/min
• IM: Glucagon 0.03–0.1 mg/kg/dose SC q20min prn; not to exceed 1 mg/dose
Disposition
• Home: Obvious cause treated, sx reversed, after high-carbohydrate meal
• Admit: No obvious cause, toxic ingestion w/ oral hypoglycemic, long acting insulin, persistent sxs