Hypoglycemia in the infant and childh

It is a medical emergency demanding immediate investigation and treatment

Definition of Hypoglycemia Plasma glucose value of less than 50mg/dl(2.8 MMOL/Lit) Lower limit acceptable during therapy for Hypoglycemia is 70 mg/dl(the goal of Therapy is to maintain plasma glucose levels in the normal range of 70-100 mg/dl most of time )

Symptoms and signs Adrenergic manifestation Nevro glycopenic manifestation

Adrenergic manifestation Sweating Shakiness Tachycardia Anxiety Weakness Hanger Naseua-vometing

Nevroglycopenia manifestation Headache Visual disturbances Lethargy Mental confusion Convulsion Hypothermia

Major causes of Hypo glicemia in the infant and childh

Hyper insulinism Aut.R(newborn period) AUT.D(infancy and childhood) With hyperammonia (infancy and childhood) Glucokinax activation(aut.D) SCHAD(loss of function mutation) Exercise Factitious Insulinoma Auto immune

Criteria for diagnosing Hyper insulinism based on critical sample Detectable insulin (>2MIU/ML) Low FFA(<1.5 MMOL/LIT) Low ketons of plaama(<2.0 MMOL/ML) Glgcemic response to 1mg intravenous glucagon at the time of fasting Hypoglycemia(≥30mg/dl glucose rising in 20 min)

Ketotic Hypoglycemia The most common form of childhood Hypoglycemia Begins between 18 months to 5 years and spontaneous remits by the age of 8-9 years Low plasma alanine level Decrease glucose production during over night fasting Low insulin level-keton body elevated High level of counter regulatory hormones Most patients are smaller than age-match control and have a history of transient neonatal Hypoglycemia

Hormone deficiency GH deficiency due to panhypopitutrism ACTH deficiency due to panhypopitutrism

Metabolic disease GSD disorder Galactosemia Organic acidemia Gluconeogenesis defect ß oxidation defect Fructose intolerance

Systemic disease Sepsis Head injury Acute hepatic failure Multiple organe failure cyanotic congenital heart disease CHF CRF Diarrhea Malaria

Drugs Ethanol Beta blocker Acetaminophen Salicylate Sulfanamid Quinine Co-TMX Pentamidine

Alimentary Hypoglycemia(late dumping) In patient with nissen fundoplication and gastrostomy tube replacement Hypoglycemia & hyperinsulinism 1-2 hours after feeding Treatment consist of acarbose-cachanel blocker octerotide-complex carbohydrate formula

Treatment Drug diazoxide D/W 15% 2-4 cc/kg state fallow by 6-8 mg/ng/min عوارض پرموئی تهوع هیپراورسیمی افزایش سن استخوانی افت فشار کاهش I9G

octerotide هر 6-12 ساعت 20 U /kg /day عوارض: ترشح تهوع – استفراغ اسهال هپاتیت سنگ کیسه صفرا درد محل تزریق surgery