the the infant and infant and childh childh
Dec 13, 2015
Hypoglycemia in theHypoglycemia in the
infant and childh infant and childh
It is a medical emergencyIt is a medical emergency
demanding immediate demanding immediate
investigation and treatment investigation and treatment
Definition of HypoglycemiaDefinition of Hypoglycemia
Plasma glucose value of less than Plasma glucose value of less than 50mg/dl(2.8 MMOL/Lit)50mg/dl(2.8 MMOL/Lit)
Lower limit acceptable during therapy forLower limit acceptable during therapy for Hypoglycemia is 70 mg/dl(the goal of Hypoglycemia is 70 mg/dl(the goal of Therapy is to maintain plasma glucose Therapy is to maintain plasma glucose
levels in the normal range of 70-100 mg/dl levels in the normal range of 70-100 mg/dl most of time )most of time )
Symptoms and signsSymptoms and signs
Adrenergic manifestationAdrenergic manifestation
Nevro glycopenic manifestationNevro glycopenic manifestation
Adrenergic manifestationAdrenergic manifestation
SweatingSweating ShakinessShakiness TachycardiaTachycardia AnxietyAnxiety WeaknessWeakness HangerHanger Naseua-vometingNaseua-vometing
Nevroglycopenia manifestationNevroglycopenia manifestation
HeadacheHeadache Visual disturbancesVisual disturbances LethargyLethargy Mental confusionMental confusion ConvulsionConvulsion HypothermiaHypothermia
Major causes of HypoMajor causes of Hypo
glicemia in the infantglicemia in the infant
and childhand childh
Hyper insulinismHyper insulinism Aut.R(newborn period)Aut.R(newborn period) AUT.D(infancy and childhood)AUT.D(infancy and childhood) With hyperammonia (infancy and childhood)With hyperammonia (infancy and childhood) Glucokinax activation(aut.D)Glucokinax activation(aut.D) SCHAD(loss of function mutation)SCHAD(loss of function mutation) ExerciseExercise FactitiousFactitious InsulinomaInsulinoma Auto immuneAuto immune
Criteria for diagnosing Hyper Criteria for diagnosing Hyper insulinism based on critical sampleinsulinism based on critical sample
Detectable insulin (>2MIU/ML)Detectable insulin (>2MIU/ML) Low FFA(<1.5 MMOL/LIT)Low FFA(<1.5 MMOL/LIT) Low ketons of plaama(<2.0 MMOL/ML)Low ketons of plaama(<2.0 MMOL/ML) Glgcemic response to 1mg intravenous Glgcemic response to 1mg intravenous
glucagon at the time of fasting glucagon at the time of fasting
Hypoglycemia(≥30mg/dl glucose rising in 20 Hypoglycemia(≥30mg/dl glucose rising in 20 min)min)
Ketotic HypoglycemiaKetotic Hypoglycemia
The most common form of childhood HypoglycemiaThe most common form of childhood Hypoglycemia Begins between 18 months to 5 years and spontaneous Begins between 18 months to 5 years and spontaneous
remits by the age of 8-9 yearsremits by the age of 8-9 years Low plasma alanine levelLow plasma alanine level Decrease glucose production during over night fastingDecrease glucose production during over night fasting Low insulin level-keton body elevatedLow insulin level-keton body elevated High level of counter regulatory hormonesHigh level of counter regulatory hormones Most patients are smaller than age-match control and Most patients are smaller than age-match control and
have a history of transient neonatal Hypoglycemiahave a history of transient neonatal Hypoglycemia
Hormone deficiencyHormone deficiency
GH deficiency due to panhypopitutrismGH deficiency due to panhypopitutrism
ACTH deficiency due to panhypopitutrismACTH deficiency due to panhypopitutrism
Metabolic diseaseMetabolic disease
GSD disorderGSD disorder GalactosemiaGalactosemia Organic acidemiaOrganic acidemia Gluconeogenesis defectGluconeogenesis defect ß oxidation defectß oxidation defect Fructose intoleranceFructose intolerance
Systemic diseaseSystemic disease SepsisSepsis Head injuryHead injury Acute hepatic failureAcute hepatic failure Multiple organe failureMultiple organe failure cyanotic congenital heart diseasecyanotic congenital heart disease CHFCHF CRFCRF DiarrheaDiarrhea MalariaMalaria
DrugsDrugs
EthanolEthanol Beta blockerBeta blocker AcetaminophenAcetaminophen SalicylateSalicylate SulfanamidSulfanamid QuinineQuinine Co-TMXCo-TMX PentamidinePentamidine
Alimentary Hypoglycemia(late dumping)Alimentary Hypoglycemia(late dumping)
In patient with nissen fundoplication and In patient with nissen fundoplication and gastrostomy tube replacement gastrostomy tube replacement
Hypoglycemia & hyperinsulinism 1-2 hours Hypoglycemia & hyperinsulinism 1-2 hours after feedingafter feeding
Treatment consist of acarbose-cachanel Treatment consist of acarbose-cachanel blocker octerotide-complex carbohydrate blocker octerotide-complex carbohydrate formulaformula
TreatmentTreatmentDrugDrug diazoxide diazoxide D/W 15% 2-4 cc/kg state fallow by 6-8 D/W 15% 2-4 cc/kg state fallow by 6-8
mg/ng/minmg/ng/minعوارضعوارض
پرموئیپرموئی1.1.
تهوعتهوع2.2.
هیپراورسیمیهیپراورسیمی3.3.
استخوانی 4.4. سن استخوانی افزایش سن افزایش
فشار 5.5. فشار افت افتI9GI9G کاهشکاهش6.6.
octerotide octerotide 2020 ساعت ساعت 1212--66هر هر U /kg /day U /kg /day
::عوارضعوارض ترشحترشح – استفراغ استفراغ – تهوع تهوعاسهالاسهالهپاتیتهپاتیت صفرا کیسه صفرا سنگ کیسه سنگ تزریق محل تزریق درد محل درد
surgerysurgery