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Hypoglycaemia

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Definition

Hypoglycaemia is defined as a venous glucose < 2.5 mmol/L as measured in the lab. If glucometer readings are low a sample must be sent to the laboratory for confirmation.

Investigation During and Acute Episode

Bloods * Urine 
Glucose  Ketones 
Free fatty acids  Organic acids
Ketones ( β hydroxybuturate)  Amino acids (optional) 
Insulin, Cortisol, Growth hormone   
Lactate / pyruvate   
Acid - base status   
Amino acids ( optional )   
Carnitine (free and acylcarnitines )   

* These tests need: 1 ml in a purple top (EDTA) tube, more than 4 mls of plasma in a green top tube, and 0.5 ml in a grey top (Fluoride tube) for lactate. All tests must go immediately to the laboratory on ice. 

Investigation of Recurrent Episodes (the Controlled Fasting Test)

Contact laboratory prior to test. This test should be done after consultation with the endocrinology team.

  1. Admit, obtain IV access. The child fasts after the evening meal. Take bloods as follows:
    • Baseline bloods (as per 'acute episode' - above) - in most cases, probably no need to do baseline insulin, cortisol, hGH
    • Blood glucose (ward glucometer): 4 hrly for 8 hrs, then 1 - 2 hrly depending on progress. Younger children 2 hrly initially. Infants hourly.
    • When glucose < 2.5 mmol, or child symptomatic, or duration of fast = 24 hours, repeat bloods as per 'acute episode". Give 30 mcg per kg glucagon (max 1 mg) IM. Measure glucose and lactate at 0, 5, 10 and 20 minutes.
    • Give IV glucose during the test if concerns (convulsion, loss of consciousness. Take bloods first).
    • Upon completion of test, feed. If the blood glucose is still low, give IV glucose as per "treatment" (below).
  2. Collect first voided urine after completion of test for ketones, organic acids and amino acids.
  3. Blood spot (Guthrie card) can be collected for common MCAD or LCHAD DNA deletions, if the fasting test is suggestive (low ketones in the presence of hypoglycaemia).

Treatment of Hypoglycaemia

Intravenous 2ml/kg of 10% Dextrose stat with repeat as necessary.

Oral versus IV treatment depends on the clinical presentation, and if in doubt treatment should be IV. If a child is normoglycaemic on arrival (e.g. due to pre-hospital treatment), and tolerating oral intake, then oral feeding can be considered.

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Document Control

  • Date last published: 18 November 2015
  • Document type: Clinical Guideline
  • Services responsible: Metabolic
  • Author(s): Callum Wilson
  • Owner: Callum Wilson
  • Editor: Greg Williams
  • Review frequency: 2 years

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