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#PEMLectures #FOAMed The focus is on hypoglycemic patients that are critically ill – but not diabetic
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#PEMLectures #FOAMed The initial priority is correcting the glucose – right before you do that send critical hypoglycemia labs!
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#PEMLectures #FOAMed http://www.clinpedemergencymed.com/article/S1522-8401(09)00093-7/abstract … Review of hypoglycemia in the ED, reviews why younger patients are more susceptible
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#PEMLectures #FOAMed What exactly defines hypoglycemia? low plasma glucose + symptoms (jittery all the way to coma) + resolution after Tx
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#PEMLectures #FOAMed exact no. below which a pt is hypoglycemic varies – a neonate could be asymptomatic at 35 – but ≤45-50 = HYPOGLYCEMIA
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#PEMLectures #FOAMed Common Etiologies – idiopathic ketotic hypoglycemia ( http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-01825-8..50032-6–cesec43&isbn=978-0-323-01825-8&type=bookPage&from=content&uniqId=441527234-2 …), sepsis, tox
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#PEMLectures #FOAMed The critical sample of labs is for glucose ≤45 – get a green top and a gold top
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#PEMLectures #FOAMed Get 2 lines – 1 to treat another to get labs – the labs of for hypoglycemia of UNKNOWN etiology
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#PEMLectures #FOAMed In difficult access do a fem stick to get blood for labs – work on peripheral access for admin of Dextrose
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#PEMLectures #FOAMed Get the labs if you can BUT THEESE NEED TO BE DONE BEFORE YOU GIVE GLUCOSE –
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#PEMLectures #FOAMed Critical labs include gluc, insulin, cortisol, GH, beta hydroxybutyrate, lactate/pyruvate, renal panel (chem-7)#PEMLectures #FOAMed …free fatty acids, C-peptide, IGF-BP1, sulfonylurea, alanine, 5ml to save (gold top) [2of2]#PEMLectures #FOAMed D10 10g/100ml, D25 25g/100ml, D50 50g/100ml#PEMLectures #FOAMed 2ml/kg of D25 in a 15kg infant = 30ml or 7.5 of sugar. this is approx 2 teaspoons. A small juice box has 18g of sugar…#PEMLectures #FOAMed D10 and D25 are the primary choices in kids. D10 <30 days, otherwise choose either#PEMLectures #FOAMed D10 5ml/kg – D25 2ml/kg IV – given IV/IO#PEMLectures #FOAMed D25 has to be reconstituted as it is somewhat hyperosmolar#PEMLectures #FOAMed D50 is mixed with sterile water to make D25 20ml D50 + 20ml sterile water#PEMLectures #FOAMed glucagon if you can’t get IV access – may not work in all scenarios (but generally won’t hurt)#PEMLectures #FOAMed now onto hyperinsulinemic hypoglycemia, causes severe persistent hypoglycemia despite Tx with repeated dextrose#PEMLectures #FOAMed http://www.nejm.org/doi/full/10.1056/NEJMoa1310967 … updated info on Hyperinsulinemic nonketotic Hypoglycemia#PEMLectures #FOAMed Hypoglycemia in non-diabetic kids is assoc with incr mortality in PICU – OR 4.49 with gluc <40storify.com
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About the Author: Brad Sobolewski, MD, MEd
Brad Sobolewski, MD, MEd is a Professor of Pediatric Emergency Medicine and an Associate Director for the Pediatric Residency Training Program at Cincinnati Children's Hospital Medical Center. He is on Twitter/X @PEMTweets, on Instagram @BradSobolewski, authors the Pediatric Emergency Medicine site PEMBlog and is the host and creator of PEM Currents: The Pediatric Emergency Medicine Podcast. All views are strictly my own and not official medical advice.
