Approach Considerations
Start a 5% or 10% dextrose drip when hypoglycemia is recurrent. In terms of prehospital care, stabilize acute, life-threatening conditions and initiate supportive therapy in patients with hypoglycemia. If a patient is alert and has intact airway protective reflexes, oral liquids containing sugar (eg, orange juice) can be administered. [14]
A study by Joshi et al suggested that in women with pregestational type 1 or type 2 diabetes, neonatal hypoglycemia can be avoided by aiming at an intrapartum blood glucose level of 4-7 mmol/L. [15]
A study by Coors et al indicated that in asymptomatic neonates at increased risk for hypoglycemia (ie, those who are late preterm, have a birth weight of < 2500 g or >4000 g, or are born to mothers with diabetes), the rates of transient neonatal hypoglycemia and neonatal intensive care unit (NICU) admissions for hypoglycemia are not reduced by the prophylactic use of dextrose gel. [16]
In contrast, a study by Makker et al reported that the adjunctive use of glucose gel in newborns at risk for neonatal hypoglycemia can reduce NICU admissions for treatment with intravenous dextrose. Reviewing outcomes for 1 year prior to the initiation of a revised newborn nursery protocol that included the use of glucose gel in at-risk infants to those at 1 year after the protocol’s initiation, transfer to the NICU for neonatal hypoglycemia therapy decreased from 8.1% to 3.7%. [17]
Emergency department care
Supportive therapy includes oxygen, establishing an intravenous (IV) line, and monitoring. Seizures unresponsive to correction of hypoglycemia should be managed with appropriate anticonvulsants. Marked acidosis (pH < 7.1) suggests shock or serious underlying disease and should be treated appropriately. The treatment goal is to maintain a blood glucose level of at least 45 mg/dL (2.5 mmol/L).
For the infant or child who does not drink but has intact airway protective reflexes, orogastric or nasogastric administration of oral liquids containing sugar may be performed.
Inpatient care
Any child with documented hypoglycemia not secondary to insulin therapy should be hospitalized for careful monitoring and diagnostic testing.
Surgery
If hypoglycemia is diagnosed in an infant younger than 3 months, surgical intervention may be necessary. Surgical exploration usually is undertaken in severely affected neonates who are unresponsive to glucose and somatostatin therapy. Near-total resection of 85-90% of the pancreas is recommended for presumed congenital hyperinsulinism, which is most commonly associated with an abnormality of beta-cell regulation throughout the pancreas. Risks include the development of diabetes.
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Normal hypoglycemic counterregulation.
