Hypoglycemia Dr. Ordooei

Definition Blood glucose below 50 mg/dl Or plasma glucose below 55 mg/dl

Symptoms and signs of hypoglycemia Epinephrine release Cerebral Glucopenia Perspiration Palpitation Headache Pallor Mental confusion Paresthesia Somnolence Trembling Dysarthria Anxiety Personality changes Weakness Hunger Nausea Convulsions Vomiting Coma

تریاد ویپل قند خون کمتر mg/dl 50 علائم هیپوگلایسمی برطرف شدن علائم با دادن گلوکز به بیمار

Pathophysiology of hypoglycemia Failure to receive or abrob nutrients  production or release of hepatic glycogen Limited substrate for gluconegenesis  Alternative fuel production  Utilization of glucose

Neonatal hypoglycemia (Transient)  Production: Premature and SGA  Utilization: hyperinsulinism

Transient hyperinsulinism Infant of diabetic mother Erythroblastosis fetalis Improper UA catheter placement Rapid Dc of IV glucose

Neonatal and infancy (Persistent) A.  Utilization Hyperinsulinemia * Endogenous * Exogenous B. Hormone Deficiencies C. Inborn Eror of Metabolism

Histologic finding in islet cell dysmaturation syndrome Islet cell hyperplasia Islet cell hypertrophy (Micro) adenoma Adenomatosis Normal histology ? Delta cell deficiency

Diagnostic criteria for hyperinsulinemic hypoglycemia Rapid development of hypoglycemia with fasting High exogenous glucose requirement to maintain normoglycemia Absence of ketonemia Serum insulin level > 5-10 u/ml at time of hypoglycemia Insulin-glucose ratio > 0.4 at time of hypoglycemia

Hypoglycemia in childhood Ketotic hypoglycemia Hormone deficiency Hepatic disease Drugs, toxins Hepatic inborn errors of metabolism

Ketotic hypoglycemia Most common form of childhood hypoglycemia Presents between the ages of 18 mo and 5 yr Remits spontaneously by the age 8-9 yr Plasma alanine , ketonemia, epinephrine secretion  High-protein, high-carbohydrate diet

Diagnostic evaluation Careful history Age of onset Relation to meals or caloric deprivation Drug ingestion Insulin injection Salt craving Growth velocity Family history

Physical examination Large plethoric appearance Hepatomegaly Microphallus Hyperpigmentation

The critical sample in the evaluation of hypoglycemia Hormones: insulin, GH, cortisol, glucagon, T.F.T Substrates: glucose, ketones, free fatty acids, Amonia, alanine, uric acid, reducing sugar 5-10 ml serum/plasma (provisional) Glucose (pre. And post glucagon)

Treatment D/W %10 2ml/kg IV IV infusion of glucose 6-8 mg/kg/min Hydrocortisone 5 mg/kg/d GH 1 U/24 hr Diazoxide 10-25 mg/kg/d PO. Octreotide 20-25 ug SC