Clinical Features

Classically, hypoglycemic patients present with either neuroglycopenic or excessive adrenergic signs and symptoms (IabJe,..12.5i3). Postprandial hypoglycemia is more likely to present with signs of adrenergic excess whereas fasting hypoglycemia commonly presents with neuroglycopenic symptoms. In general, the more rapid the decrease in glucose concentration, the more adrenergic-type symptoms will be noted. Variability and crossover in symptoms is the rule, however, and not the exception. Neonates and young children may present with poor feeding, jitteriness, emesis, ravenous hunger, lethargy, altered personality, repetitive colic-like symptoms, hypotonia, or hypothermia. In other cases they unfortunately present after an apparent life-threatening event, seizure, or cardiac arrest. As children grow older they begin to present more like adults, with signs of adrenergic excess and then neuroglycopenia. If treatment is not forthcoming, the adrenergic symptoms may abate, leaving only the neuroglycopenic ones. In some cases, as with type I glycogen storage disease, patients may have no obvious symptoms despite an incredibly low blood glucose concentration. Children with unexplained catastrophic presentations such as coma, severe hypothermia, and arrest should have bedside glucose testing performed immediately and, if clinically indicated, a specimen should be sent for formal laboratory evaluation as well. Empirically treating patients after cardiac arrest with glucose may worsen neurologic outcomes, as hyperglycemia is detrimental in cases of cerebral edema and anoxia. Therefore, whenever possible, bedside testing and historical data surrounding the event should guide therapy in this population. Hypoglycemia should be suspected in all moderately to severely injured or ill children. The underlying disease process will often mask the symptoms of hypoglycemia. Children with increased physiologic stress require periodic reevaluation for hypoglycemia, as they are often unable to maintain sufficient glucose influx to meet their increased needs. This is especially true in patients whose illness, injury, or treatment prevents them from being able to express their needs.

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