How is pediatric hypoglycemia diagnosed?

Updated: Sep 12, 2019
  • Author: Robert P Hoffman, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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The presence of hypoglycemia should prompt a thorough investigation for counterregulation abnormalities or a lack of alternative substrate. Plasma glucose concentrations should be measured in all neonates and children with the symptoms listed above (see History), with due consideration given to the temporal relationships of the test samples. [14]

The exact glucose level that constitutes hypoglycemia is debatable, particularly in neonates. Older literature suggests levels of more than 1.7 mmol/L are acceptable in this age group. Newer publications suggest levels of less than 2.5 mmol/L are inappropriate. The Whipple triad is used to support a diagnosis of hypoglycemia and its symptomatic consequences. The triad consists of (1) the presence of symptoms likely or known to be caused by hypoglycemia, (2) a low plasma glucose concentration when symptoms are present, and (3) subsequent relief of symptoms when the hypoglycemia is corrected.

The plasma glucose concentration should ideally be measured with a laboratory-based glucose analyzer. [15] If this is unavailable, home blood-glucose monitors may be used; however, their accuracy in the low range is questionable, and they have been shown to provide false-positive and false-negative results.

Screening for hypoglycemia in the asymptomatic neonate is controversial. Studies suggest that screening is appropriate in infants of mothers with diabetes, infants who are large or small for their gestational age, and infants who are premature. Screening should begin within the first 2-3 hours of life and continue through the first 24 hours of life.

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