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Hypoglycemia in the infant and childh

Hypoglycemia in the infant and childh

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Hypoglycemia in the infant and childh

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  1. Hypoglycemia in the infant and childh

  2. It is a medical emergency demanding immediate investigation and treatment

  3. Definition of Hypoglycemia • Plasma glucose value of less than 50mg/dl(2.8 MMOL/Lit) • Lower limit acceptable during therapy for Hypoglycemia is 70 mg/dl(the goal of Therapy is to maintain plasma glucose levels in the normal range of 70-100 mg/dl most of time )

  4. Symptoms and signs • Adrenergic manifestation • Nevro glycopenic manifestation

  5. Adrenergic manifestation • Sweating • Shakiness • Tachycardia • Anxiety • Weakness • Hanger • Naseua-vometing

  6. Nevroglycopenia manifestation • Headache • Visual disturbances • Lethargy • Mental confusion • Convulsion • Hypothermia

  7. Major causes of Hypo glicemia in the infant and childh

  8. Hyper insulinism • Aut.R(newborn period) • AUT.D(infancy and childhood) • With hyperammonia (infancy and childhood) • Glucokinax activation(aut.D) • SCHAD(loss of function mutation) • Exercise • Factitious • Insulinoma • Auto immune

  9. Criteria for diagnosing Hyper insulinism based on critical sample • Detectable insulin (>2MIU/ML) • Low FFA(<1.5 MMOL/LIT) • Low ketons of plaama(<2.0 MMOL/ML) • Glgcemic response to 1mg intravenous glucagon at the time of fasting Hypoglycemia(≥30mg/dl glucose rising in 20 min)

  10. Ketotic Hypoglycemia • The most common form of childhood Hypoglycemia • Begins between 18 months to 5 years and spontaneous remits by the age of 8-9 years • Low plasma alanine level • Decrease glucose production during over night fasting • Low insulin level-keton body elevated • High level of counter regulatory hormones • Most patients are smaller than age-match control and have a history of transient neonatal Hypoglycemia

  11. Hormone deficiency • GH deficiency due to panhypopitutrism • ACTH deficiency due to panhypopitutrism

  12. Metabolic disease • GSD disorder • Galactosemia • Organic acidemia • Gluconeogenesis defect • ß oxidation defect • Fructose intolerance

  13. Systemic disease • Sepsis • Head injury • Acute hepatic failure • Multiple organe failure • cyanotic congenital heart disease • CHF • CRF • Diarrhea • Malaria

  14. Drugs • Ethanol • Beta blocker • Acetaminophen • Salicylate • Sulfanamid • Quinine • Co-TMX • Pentamidine

  15. Alimentary Hypoglycemia(late dumping) • In patient with nissen fundoplication and gastrostomy tube replacement • Hypoglycemia & hyperinsulinism 1-2 hours after feeding • Treatment consist of acarbose-cachanel blocker octerotide-complex carbohydrate formula

  16. Treatment Drug • diazoxide • D/W 15% 2-4 cc/kg state fallow by 6-8 mg/ng/min عوارض • پرموئی • تهوع • هیپراورسیمی • افزایش سن استخوانی • افت فشار • کاهش I9G

  17. octerotide هر 6-12 ساعت 20 U /kg /day عوارض: • ترشح • تهوع – استفراغ • اسهال • هپاتیت • سنگ کیسه صفرا • درد محل تزریق surgery