1. Hypoglycemia in the infant and childh

2. It is a medical emergency
demanding immediate
investigation and treatment

3. 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 mg/dl most of time )

7. Symptoms and signs Adrenergic manifestation
Nevro glycopenic manifestation

8. Adrenergic manifestation
Sweating
Shakiness
Tachycardia
Anxiety
Weakness
Hanger
Naseua-vometing

9. Nevroglycopenia manifestation
Headache
Visual disturbances
Lethargy
Mental confusion
Convulsion
Hypothermia

11. Major causes of Hypo
glicemia in the infant
and childh

12. 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

15. 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)

16. 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

17. Hormone deficiency GH deficiency due to panhypopitutrism
ACTH deficiency due to panhypopitutrism

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

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

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

21. 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

22. 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

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