1. Hypoglycemia
Dr. Ordooei

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

3. 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

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

5. 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

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

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

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

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

10. 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

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

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

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

14. Physical examination Large plethoric appearance Hepatomegaly
Microphallus
Hyperpigmentation

16. 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)

17. 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 mg/kg/d PO.
Octreotide ug SC