PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN
Hypoglycaemia is defined as blood sugar level <2.6mmol/l.
Paediatric Hypoglycaemia Investigations should be performed in ALL patients with a blood sugar <2.6mmol/l)

Hypoglycaemia is a sign of underlying disease that interferes with at least one of the following processes:
- Carbohydrate intake
- Carbohydrate absorption
- Gluconeogenesis
- Glycogenolysis
Gluconeogenesis is a metabolic pathway that results in the generation of glucose from non-carbohydrate substrates e.g. pyruvate, lactate, glycerol. It mainly occurs in the liver but also to some extent in the cortex of the kidneys. The process occurs during periods of fasting, starvation, low carb diets or intense exercise. It is often associated with ketosis.
Glycogenolysis is the breakdown of glycogen and takes place in the cells of muscle (to provide energy for contraction) and hepatocytes (to release glucose into the blood stream for uptake by other cells).
Causes of hypoglycaemia
Inadequate glucose intake/ production
Systemic/ Nutrition
- Starvation
- Malnutrition
- Sepsis
- Malabsorption
Metabolic
- Ketotic hypoglycaemia “accelerated starvation”
- Glycogen storage disease
- Galactosaemia
- Organic acidaemia
- Carnitine deficiency
- Acyl CoA Dehydrogenase deficiency
Endocrine
- Hyperinsulinism
- Hypopituitarism
- Growth hormone deficiency
- Hypothyroidism
- Congenital adrenal hyperplasia
Hepatic
- Hepatitis
- Cirrhosis
- Reye Syndrome
Toxic
- Aspirin
- Alcohol
- Insulin
- Valproate
Signs & Symptoms
The signs and symptoms of hypoglycaemia vary greatly between individuals. Neurological features occur due to impaired glucose supply to the brain.
Symptoms | Signs | |
Mild | Sweating Headache Anxiety | Tremor Pallor Tachycardia |
Moderate | Jelly Legs Difficulty Concentrating | Change in behaviour Lethargy Slurred speech Unsteady gait Confused |
Severe | Dizziness Visual disturbance | Altered Consciousness Convulsions |
Important points to cover in patient history
Past history
- Similar episodes in the past (these may have been unrecognised as being caused by hypoglycaemia e.g. seizures)
- Neonatal hypoglycaemia
Family history
- Unexplained infant deaths (consider inborn errors of metabolism)
- Some hormone or insulin problems may be familial
Relation to foods
- Milk (galactosaemia)
- Juice (hereditary fructose intolerance)
- Protein (amino acid or organic acid disorder)
Possible access to medicines/ alcohol
- Oral hypoglycaemia agents
- Alcohol
- Aspirin
- B-Blockers
- Insulin
Investigations
Bloods
Use Paediatric Hypoglycaemia grab bag – Found in Ward Treatment Room or ED.
Details for Paediatric Hypoglycaemia grab bag also found at the end of this document.
These bloods are ideally taken before dextrose is given. Aim for 12ml but minimum 5ml.
Bloods should be taken promptly after collection to labs, avoid POD system.
Urine
Urinary ketones & Urinary organic acid.
“HYPOGLYCAEMIA INVESTIGATIONS BAG” – Hypo Grab Bag
Paediatric Hypoglycaemia Investigations (to be performed in ALL patients with a blood sugar <2.6mmol/l)
- List of bloods required including sample requirements and tube colour in each IV trolley in “Hypoglycaemia Investigations Bag”.
- Some samples are time critical and should ideally be taken prior to administration of sugar.
- Time critical samples will be highlighted in BOLD
- Total requirements for all tests is 9.5ML OF BLOOD, CAPILLARY BLOOD GAS TUBE, GUTHRIE CARD AND 5ML OF URINE
- (9.5ml if performing blood culture), (5.1mls for time critical samples only plus gas)
- Hypoglycaemia screen can be requested on order comms by selecting Paediatric Hypoglycaemia.
Tests | Bottle type | Minimum volume requirement |
Glucose Free Fatty Acid (time critical) | Fluoride oxalate (yellow) | ONE FULL 2.7ml paediatric tube |
Ketones (time critical) | Blood ketone meter | |
Lactate (capillary gas) (time critical) | Capillary blood gas tube | ONE FULL capillary gas tube |
Insulin C-peptide Beta-hydroxybutyrate Cortisol (time critical) | Lithium Heparin (orange) | TWO FULL 1.2ml paediatric tubes |
TOTAL time critical volume 5.1mls + Gas | ||
U+E LFT CRP | Lithium Heparin (orange) | ONE HALF FULL 1.2ml paediatric tube |
Ammonia | EDTA (pink) | ONE FULL 1.2ml paediatric tube |
FBC | EDTA (pink) | ONE HALF FULL 1.2ml paediatric tube |
Acylcarnitine | Guthrie spot card | |
Blood Culture (if suspected sepsis/neonate) | Blood culture bottle | 2ml |
URINE organic acids, amino acids, ketones, glucose (first void urine after hypo) | White universal container and urine dip | 5ml |
Minimum 9.5 mls total & Guthrie card & Gas |