Pediatric emergency medicine trisk 1875 1875
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TABLE 89.4
CAUSES OF CHILDHOOD HYPOGLYCEMIA
Decreased availability of glucose
Decreased intake—fasting, malnutrition, illness
Decreased absorption—acute diarrhea
Inadequate glycogen reserves—defects in enzymes of glycogen synthetic pathways
Ineffective glycogenolysis—defects in enzymes of glycogenolytic pathways
Inability to mobilize glycogen—glucagon deficiency
Ineffective gluconeogenesis—defects in enzymes of gluconeogenic pathway
Increased use of glucose
Hyperinsulinism—islet cell adenoma or hyperplasia, ingestion of oral hypoglycemic agents,
insulin therapy
Large tumors—Wilms tumor, neuroblastoma
Diminished availability of alternative fuels
Decreased or absent fat stores
Inability to oxidize fats—enzymatic defects in fatty acid oxidation
Unknown or complex mechanisms
Sepsis/shock
Reye syndrome
Salicylate ingestion
Ethanol ingestion
Adrenal insufficiency
Hypothyroidism
Hypopituitarism
Clinical Considerations
Clinical Recognition
The acutely ill child warrants a glucose determination if the level of consciousness is altered
because hypoglycemia may accompany an illness that interferes with oral intake. The
symptoms and signs of hypoglycemia are nonspecific and are often overlooked, especially in
the infant and young child. Any child presenting with a seizure, other than a breakthrough
seizure with known epilepsy, or an altered level of consciousness should have a plasma
glucose determination.
Triage
Children with known diabetes who appear ill need a rapid bedside glucose for possibility of
hypoglycemia or hyperglycemia. All children with acute alterations in consciousness,
