No one likes to be made to look like a fool, but overlooking the potential for hypoglycemia is a guaranteed way to cause you to facepalm yourself.
Having been on the receiving end of the facepalm over missed hypoglycemia too many times to declare, let’s use this Morsel as a declaration that we will be every vigilant against the Hypoglycemia Ambush!
- Can be vague!
- A rapid decrease in blood glucose levels (as might be seen with too much insulin) can lead to Adrenergic symptoms:
- Anxiety, tremors
- Weakness, hunger
- Tachycardia, diaphoresis
- A gradual decline in blood glucose (ex, Fasting due to gastroenteritis) can lead to neuroglycopenic symptoms:
- Headache, confusion
- Malaise, fatigue
- Abnormal behavior or even psychosis
- Neurologic deficits (even focal)
- Neonates are even more difficult (Naturally)!
- Neonates can tolerate lower glucose levels without frank symptoms.
- Symptoms are generally vague and nonspecific as well:
- Tremor, jitteriness
- Feeding difficulties
- Irritability, high-pitched cry
- Symptoms can also be quite dramatic:
- Convulsions / Seizures (see Neonatal Seizures)
Hypoglycemia as a Symptom
- While considering the presence of hypoglycemia is paramount, the next consideration is why is it present?
- Hypoglycemia can be a symptom or component of a vast number of severe pediatric conditions:
- Hypoglycemia can also be a complicate more “minor” conditions:
- Children have higher metabolic rates and lower glycogen stores.
- An illness that affects their input of more fuel (ie, sugar) can lead to hypoglycemia.
- Acute Gastroenteritis is a great example!
So, the next time you are wondering what this odd collection of symptoms means – check a sugar.
Or the next time you think the kid with gastroenteritis needs an IV, because he “looks punky,” but doesn’t actually have signs of dehydration – check a sugar.
Or the next time someone asks your opinion to help develop a differential diagnosis list – say hypoglycemia.
Hypoglycemia – the Syphilis of electrolyte derangement.