Pediatric emergency medicine trisk 1873 1873
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (162.46 KB, 1 trang )
of 150 to 250 mg/dL. Additional supplemental insulin may be required, depending on when
the child last received insulin and the response to simple hydration.
Note, if hyperglycemia is a coincidental finding, the diagnosis requires thoughtful
consideration. How traumatic was the blood draw? How upset was the child? What
medications or IV fluids were given to the child just before the phlebotomy? What was the
child drinking while waiting to see the physician? Are the symptoms in any way related to the
hyperglycemia? How sick is the child? The sicker the child is, the less likely it is that
hyperglycemia is reflective of diabetes. Three simple evaluations are helpful in determining
whether the hyperglycemia is circumstantial or suggestive of diabetes. Brief hyperglycemia
resulting from a stress response to phlebotomy or secondary to oral intake rarely results in
significant glucosuria; therefore, a urine dip for glucose is often helpful. Second, in the
absence of ongoing stress or input, glucose tends to fall over time. A point-of-care glucose is
rarely stressful. Therefore, repeating a glucose measurement by fingerstick 1 to 2 hours after
the original sample was sent is useful in separating disease from nondisease. Third,
hyperglycemia secondary to these factors is usually mild (150 to 250 mg/dL). More significant
hyperglycemia should raise the suspicion of diabetes, glucose intolerance, or an underlying
medical illness that is producing a significant counterregulatory response.
HYPOGLYCEMIA
Goal of Treatment
To recognize hypoglycemia, initiate a diagnostic laboratory evaluation, and begin corrective
treatment immediately if exhibiting any symptoms.
CLINICAL PEARLS AND PITFALLS
Hypoglycemia in absence of ketones is consistent with hyperinsulinism or fatty acid
oxidation enzyme deficiencies.
Every acutely ill child with an altered level of consciousness should have a rapid
bedside glucose determined.
Treat severe hypoglycemia with rapid IV administration of 0.25 g dextrose per
kilogram body weight.
Current Evidence
Hypoglycemia is generally defined as plasma glucose of less than 50 mg/dL, regardless of
whether symptoms are present. A differential diagnosis of hypoglycemia, as it may present in
the ED, is provided in Table 89.4 . Hypoglycemia may be secondary to insulin therapy for
diabetes. Excluding this category, almost all hypoglycemia in children occurs during periods
of decreased or absent oral intake, often coupled with increased energy demand (e.g., viral
gastroenteritis with fever). Postprandial hypoglycemia is unusual in children, except in those
who have had prior gastrointestinal surgery. A few select poisonings can produce
hypoglycemia. Because glucose is necessary for cellular energy production in most human
tissues, the maintenance of an adequate blood glucose concentration is important for normal
function. The plasma glucose reflects a dynamic balance among glucose input from dietary
