see also: [[hypoglycaemia|hypoglycemia]] > [!Key points] > - **<3.3 mmol/L** > - in neonates <48 hr, hypoglycaemia **<2.6 mmol/kg** > - ALOC: Tx 10% dextrose 2mL/kg or IM glucagon # causes ## neonate <72 hr - premi - perinatal asphyxia - hypothermia - sepsis - resp distress - mum [[Diabetes type 1|diabetes]] - macrosomia - syndrome - pancreatic dysfunction ## infant-2 years - **congenital hyperinsulinism** (most common) - inborn errors of metabolism - growth hormone def ## child - starvation - hypopituitarism - growth hormone def ## adolescent - insulinoma - [[Adrenal insufficiency]] - eating disorder ## all - diabetes complication - sepsis - congenital heart disease - tumour - adrenal insufficiency # Treatment glucagon 100-200 mcg/kg IM ![[Pasted image 20230818230350.png]] ## discharge requirements - cause for hypoglycaemia must be known prior to d/c - neonates: BGL >2.6 for 3 consecutive normal feeds - infants and older children: BGL >3 for at least 4 hours post feeds/meals # investigations - vbg - glucose - confirm ↓ glucose - ==ketones== - *low* in hyperinsulinaemia, fatty acid oxidation defect - [[Lactic acidosis|lactate]] -- ↑ in metabolic liver disease, glycogen storage disorders, sepsis, long seizure - free fatty acids -- fatty acid oxidation defect - carnitine/acylcarnitine - fatty acid oxidation defect - ammonia -- organic acidaemias, tyrosinaemia, liver dysfunction, hyperinsulinism hyperammoniaemia syndrome - insulin - C-peptide (should not be detectable) - growth hormone - electrolytes -- consider [[Adrenal insufficiency|Congenital adrenal hyperplasia]] - urine -- glucose, ketones, reducing substances # interpret test results ![[Pasted image 20230818230510.png]]