eMedicine Specialties > Emergency Medicine > Pediatric

Pediatrics, Hypoglycemia: Follow-up

Author: Hilarie Cranmer, MD, MPH, FACEP, Director, Global Women's Health Fellowship, Associate Director, Harvard International Emergency Medicine Fellowship, Department of Emergency Medicine, Brigham and Women's Hospital; Director, Humanitarian Studies Program, Harvard Humanitarian Initiative; Assistant Professor, Harvard University School of Medicine
Coauthor(s): Michael Shannon, MD, MPH,†, Professor, Department of Pediatrics, Harvard Medical School; Chief and CHB Chair, Division of Emergency Medicine, Children's Hospital
Contributor Information and Disclosures

Updated: Aug 10, 2009

Follow-up

Further Inpatient Care

  • Any child with documented hypoglycemia not secondary to insulin therapy should be hospitalized for careful monitoring and diagnostic testing.

Deterrence/Prevention

  • Educate pregnant women with diabetes and have low threshold to screen newborns at risk for hypoglycemia.

Complications

  • Severe or long-term hypoglycemia may lead to brain damage and can also include developmental delay, heart failure, mental retardation, and seizures.

Prognosis

  • Remission of congenital hyperinsulinism generally does not occur, but the severity of the disease may decrease with time.

Patient Education

  • Provide genetic counseling for families with affected children, including information about a possible 25% risk of recurrence.

Miscellaneous

Medicolegal Pitfalls

  • Lack of vigilance with recurrent hypoglycemia in the ED
  • Failure to do a sepsis workup
  • Failure to consider the diagnosis of hypoglycemia, especially in a patient with sustained or repetitive episodes of hypoglycemia with resulting seizures and mental retardation
  • Failure to start 5% or 10% dextrose drip when hypoglycemia is recurrent
 
Acknowledgments

Professor Michael Shannon, MD, MPH, died prematurely and unexpectedly in March of 2009. He is sorely missed, least of which as a co-author for this article. To appreciate his life, please visit his obituary from the Boston Globe.



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References
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References

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  2. [Guideline] Newborn Nursery QI Committee. Portland (ME): The Barbara Bush Children's Hospital at Maine Medical Center; 2004 Jul. Neonatal hypoglycemia: initial and follow up management. National Guideline Clearinghouse. 2004;[Full Text].

  3. Narchi H, Skinner A, Williams B. Small for gestational age neonates - are we missing some by only using standard population growth standards and does it matter?. J Matern Fetal Neonatal Med. Jun 29 2009;1-7. [Medline].

  4. Boluyt N, van Kempen A, Offringa M. Neurodevelopment after neonatal hypoglycemia: a systematic review and design of an optimal future study. Pediatrics. Jun 2006;117(6):2231-2243. [Medline].

  5. Cornblath M, Hawdon JM, Williams AF, et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics. May 2000;105(5):1141-5. [Medline].

  6. Fleisher G, ed. Pediatric hypoglycemia. In: Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins; 2000.

  7. Halamek LP, Benaron DA, Stevenson DK. Neonatal hypoglycemia, Part I: Background and definition. Clin Pediatr (Phila). Dec 1997;36(12):675-80. [Medline].

  8. Losek JD. Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation. Ann Emerg Med. Jan 2000;35(1):43-6. [Medline].

  9. Lteif AN, Schwenk WF. Hypoglycemia in infants and children. Endocrinol Metab Clin North Am. Sep 1999;28(3):619-46, vii. [Medline].

  10. Muller D, Zimmering M, Roehr CC. Should nifedipine be used to counter low blood sugar levels in children with persistent hyperinsulinaemic hypoglycaemia?. Arch Dis Child. Jan 2004;89(1):83-5. [Medline].

  11. Raghuveer TS, Garg U, Graf WD. Inborn errors of metabolism in infancy and early childhood: an update. Am Fam Physician. Jun 1 2006;73(11):1981-90. [Medline].

  12. Reid SR, Losek JD, Gideon Bosker, ed. Hypoglycemia in infants and children. In: The Textbook of Primary and Acute Care Medicine. 2003.

  13. Sperling MA, Behrman RE, Kliegman RM, et al, eds. Hypoglycemia. In: Nelson Textbook of Pediatrics. 15th ed. 1996.

  14. Stanley CA. Hyperinsulinism in infants and children. Pediatr Clin North Am. Apr 1997;44(2):363-74. [Medline].

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Further Reading

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Keywords

hypoglycemia, low blood sugar in children, low blood sugar in newborns, hypoglycemia in infancy, persistent hyperinsulinemic hypoglycemia of infancy, PHHI, brain damage, hyperinsulinism, sepsis, large for gestational age, LGA, small for gestational age, SGA, intrauterine growth restriction, infant of diabetic mother, gestational diabetes, chorioamnionitis, hypoxia, perinatal distress, isolated hepatomegaly, glycogen storage disease, microcephaly, anterior midline defects, gigantism, macroglossia, hemihypertrophy, Beckwith-Wiedemann Syndrome, inborn error of metabolism, galactosemia, lactic acidosis, personality disorder, polycythemia, treatment, diagnosis

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Contributor Information and Disclosures

Author

Hilarie Cranmer, MD, MPH, FACEP, Director, Global Women's Health Fellowship, Associate Director, Harvard International Emergency Medicine Fellowship, Department of Emergency Medicine, Brigham and Women's Hospital; Director, Humanitarian Studies Program, Harvard Humanitarian Initiative; Assistant Professor, Harvard University School of Medicine
Hilarie Cranmer, MD, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Massachusetts Medical Society, Physicians for Human Rights, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Shannon, MD, MPH,†, Professor, Department of Pediatrics, Harvard Medical School; Chief and CHB Chair, Division of Emergency Medicine, Children's Hospital
Disclosure: Nothing to disclose.

Medical Editor

Debra Slapper, MD, Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital
Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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