Pediatric Hypoglycemia Differential Diagnoses
- Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD more...
Diagnostic Considerations
Many physicians may fail to recognize hypoglycemia in affected patients, either initially or over the long term. Clinical symptoms of hypoglycemia may be subtle or overt, but they are not specific to hypoglycemia and are frequently attributed to other disorders. This is particularly true if the patient has had another neurologic insult, such as head trauma or hypoxia.
Plasma glucose levels should be tested in any patient who presents with neurologic deficits at the time the deficits are present. This may prevent prolonged, inappropriate, ineffective anticonvulsant therapy in children who initially present with seizures. Failure to recognize hypoglycemia can lead to permanent impairments or death if the condition is not treated. Hypoglycemia has been reported in individuals who were thought to be comatose secondary to head trauma.
A second area of concern involves children with hypoglycemia due to abuse or Münchausen syndrome by proxy. The possibility of exogenous insulin administration must be considered and, if found, reported to the appropriate authorities.
Conditions to consider in the differential diagnosis of hypoglycemia include the following:
- Addison disease
- Adrenal crisis
- Exogenous insulin administration
- Medium chain acyl-CoA dehydrogenase deficiencies
- Sepsis
- Hyperthyroidism
- Hypopituitarism
- Glycogen-storage disease type 0
- Glycogen-storage disease type I
- Glycogen-storage disease type IV
- Glycogen-storage disease type V
- Glycogen-storage disease type VI
Differential Diagnoses
- Growth Hormone Deficiency
- Hyperinsulinemia
- Infant of Diabetic Mother
- Malnutrition
- Maple Syrup Urine Disease
- Panhypopituitarism
- Prematurity
- Toxicity, Ethanol
- Toxicity, Oral Hypoglycemic Agents
- Toxicity, Salicylate
de Lonlay P, Giurgea I, Sempoux C, Touati G, Jaubert F, Rahier J, et al. Dominantly inherited hyperinsulinaemic hypoglycaemia. J Inherit Metab Dis. 2005;28(3):267-76. [Medline].
Di Candia S, Gessi A, Pepe G, et al. Identification of a diffuse form of hyperinsulinemic hypoglycemia by 18-fluoro-L-3,4 dihydroxyphenylalanine positron emission tomography/CT in a patient carrying a novel mutation of the HADH gene. Eur J Endocrinol. Jun 2009;160(6):1019-23. [Medline].
DePuy AM, Coassolo KM, Som DA, Smulian JC. Neonatal hypoglycemia in term, nondiabetic pregnancies. Am J Obstet Gynecol. May 2009;200(5):e45-51. [Medline].
Tita AT, Landon MB, Spong CY, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med. Jan 8 2009;360(2):111-20. [Medline].
Daly LP, Osterhoudt KC, Weinzimer SA. Presenting features of idiopathic ketotic hypoglycemia. J Emerg Med. Jul 2003;25(1):39-43. [Medline].
[Guideline] Wight N, Marinelli KA. ABM clinical protocol #1: guidelines for glucose monitoring and treatment of hypoglycemia in breastfed neonates. Breastfeed Med. Autumn 2006;1(3):178-84. [Medline].
Print
