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!

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:
    • Convulsions / Seizures  (see Neonatal Seizures)
    • Tachypnea
    • Apnea
    • Coma

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:
  • Sepsis
  • Congenital Heart Disease
  • Respiratory Distress
  • Endocrine deficiencies (See Congenital Adrenal Hyperplasia for example)
  • Inborn Errors of Metabolism (see Morsel)
  • Intoxications (see Ethanol Poisoning)
• 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.