Pediatric Hypoglycemia

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    Pediatric Hypoglycemia

    A 3 year old M presents to the ED with lethargy.  Fingerstick is 38.

    How do you give this kid sugar??

    IV dextrose is the primary treatment, at a dose of 0.5-1 mg/kg

    Practically speaking this translates into 5ml/kg of D10 for newborns, and 2ml/kg of D25 for infants and children.  Of note, it is sometimes recommended to give 0.2ml/kg of D10 as a bolus prior to infusion for neonates.  In these patients it has been shown to reduce rebound hypoglycemia due to endogenous insulin release in response to hyperglycemia from a larger bolus of glucose.

    In adolescents and adults the dose is 1ml/kg of D50 (we usually give 2 amps)

    Recommendations are nicely summarized in the table below:

    Patient Age Dextrose Bolus Dose Dextrose Maintenance Dosage Other Treatments to Consider
    Neonate D10 5 mL/kg PO/NG/IV/IO 6 mL/kg/h D10 Glucagon, 0.3 milligram/kg IM
    Hydrocortisone, 25 grams PO/IM/IV/IO
    Infant D10 5 mL/kg PO/NG/IV/IO 6 mL/kg/h D10 Glucagon, 0.3 milligram/kg IM
    or Hydrocortisone, 25 grams PO/IM/IV/IO
    D25 2 mL/kg
    Child D25 2 mL/kg PO/NG/IV/IO 6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg Glucagon, 0.3 milligram/kg/IM
    Hydrocortisone, 50 grams PO/IM/IV/IO
    Adolescent 6 mL/kg/h D10 for the first 10 kg + 3 mL/kg/h for 11–20 kg + 1.5 mL/kg/h for each additional kg >20 kg Glucagon, 0.3 milligram/kg IM
    Hydrocortisone, 100 grams PO/IM/IV/IO

    References:

    Qureshi N, Al-Mogbil M, Kentab OY. Hypoglycemia and Metabolic Emergencies in Infants and Children. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study GuideNew York, NY: McGraw-Hill; 2011.http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=693&Sectionid=45915475. Accessed October 16, 2014.

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