Submitted to: Book Chapter
Publication Type: Book / Chapter
Publication Acceptance Date: March 3, 2003
Publication Date: March 15, 2004
Citation: Sunehag, A., Haymond, M. 2004. Hypoglycemia in infants and children. In: Kleinman, R.E., editor. Pediatric Nutrition Handbook. 5th edition. Elk Grove Village, IL: American Academy of Pediatrics. p. 515-535. Technical Abstract: In healthy individuals, maintenance of a normal plasma glucose concentration depends on a normal endocrine system for 1) integrating and modulating substrate mobilization, interconversion, and utilization; 2) functionally intact enzymes for glycogenolysis, glycogen synthesis, glycolysis, gluconeogenesis, and utilization of other metabolic fuels for oxidation and storage; and 3) an adequate supply of endogenous fat, glycogen, and potential gluconeogenic substrates (eg, amino acids, glycerol, and lactate). Adults are capable of maintaining a near normal blood glucose concentration, even when totally deprived of calories for weeks or, in the case of obese subjects, for months. In contrast, the healthy neonate and young child are less able to meet the obligatory demands for this metabolic fuel and exhibit a progressive fall in the plasma concentration of glucose to hypoglycemic values when they fast for even short periods (24 to 48 hours). Abnormalities in hormone secretion, substrate interconversion, and mobilization of metabolic fuels contribute to abnormalities in glucose production and utilization that ultimately result in hypoglycemia in the pediatric patient. To evaluate and treat the child with hypoglycemia appropriately, the factors that regulate glucose metabolism in adults and the unique aspects of glucose metabolism in infants and young children must be understood.