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Home | Articles | Emergencies | PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN  

PAEDIATRIC HYPOGLYCAEMIA MANAGEMENT in NON DIABETIC CHILDREN  

Last updated 1st June 2023

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  
MildSweating
Headache  
Anxiety 
Tremor 
Pallor  
Tachycardia

ModerateJelly Legs 
Difficulty Concentrating
Change in behaviour 
Lethargy 
Slurred speech 
Unsteady gait 
Confused  
SevereDizziness 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