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.

Facepalm Sugar

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!

Hypoglycemia Symptoms

  • 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)
    • Seizures
    • Coma
  • 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:

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.

Sean M. Fox
Sean M. Fox

I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.

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