How are critical sample findings interpreted for the diagnosis of pediatric hypoglycemia?

Updated: Feb 19, 2018
  • Author: Robert P Hoffman, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Answer

Metabolically, plasma free fatty acid levels should increase to more than 0.5 mmol/L, and beta-hydroxybutyrate levels should increase to more than 1 mmol/L to provide alternative fuel. A failure of both to increase suggests hyperinsulinemic lipolytic suppression. An increase in free fatty acid levels to more than 3 mmol/L without an increase in beta-hydroxybutyrate levels suggests a defect in fatty acid metabolism. (See the diagram below.)

Interpretation of the critical sample. Interpretation of the critical sample.

High plasma lactate levels suggest gluconeogenesis, glycolysis, or respiratory-chain defects. Plasma insulin levels should be suppressed, and cortisol levels should be increased (>550 nmol/L [20 mcg/dL]). Growth hormone levels should also be increased (>6 mcg/L).


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