Title: Approach to Hypoglycemia in Infants and Children Authors
Submitted to: Electronic Publication
Publication Type: Other
Publication Acceptance Date: May 10, 2004
Publication Date: August 1, 2005
Citation: Sunehag, A.L., Haymond, M.W. 2005. Approach to hypoglycemia in infants and children. UpToDate Online Journal [serial online]. Available: http://uptodateonline.com. Technical Abstract: Numerous diagnostic procedures are available to clarify the pathogenesis of the various hypoglycemic disorders, but a systematic approach will yield the most interpretable results. The results obtained from the history, physical examination, and initial plasma samples should guide further testing. The history in a hypoglycemic child should include a thorough exploration of the past medical history (birth weight, gestational age, and whether the child had hypoglycemic symptoms at birth or in the neonatal period What was the age at the onset of symptoms? Inborn errors of metabolism and congenital hormone deficiencies usually present in the neonatal period or the first two years of life; ketotic hypoglycemia, isolated growth hormone deficiency, and cortisol deficiency are usually present after one year of age. Ingestion should be considered in children who present as toddlers and young children. The details of the acute event should include information about the child's dietary intake before the event. Did acute illness prevent the child from achieving adequate carbohydrate intake? Was the child in the fed or fasting condition at the time of hypoglycemia? All of this information can help to narrow the differential diagnosis. A family history of Reye syndrome, unexplained infant deaths, or other affected family members suggests an inborn error of metabolism, particularly a fatty acid oxidation defect. Hormonal deficiencies and hyperinsulinism also may run in families. A physical examination may provide important clues to the diagnosis. The child's weight and length or height should be measured and plotted on an appropriate growth chart, and the child's growth trajectory should be evaluated. Short stature may indicate hypopituitarism or growth hormone deficiency.