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Pediatr Emerg Care. 2018 Oct 25. doi: 10.1097/PEC.0000000000001634. [Epub ahead of print]

The Incidence and Etiology of Previously Undiagnosed Hypoglycemic Disorders in the Emergency Department.

Author information

1
Departments of Endocrinology and Diabetes and.
2
Emergency Medicine, Cook Children's Medical Center, Fort Worth, TX.
3
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Abstract

OBJECTIVE:

The aim of this study was to determine the incidence and etiology of previously undiagnosed hypoglycemia in children (<18 years of age) seen in a hospital emergency department (ED).

METHODS:

A retrospective review of all emergency room visits over a 2-year period was conducted to identify patients younger than 18 years who had hypoglycemia (<50 mg/dL) not associated with a previously known cause. Evaluation of hypoglycemia was conducted during a spontaneous hypoglycemic event or during hypoglycemia induced by a fasting study. Insulin and counter-regulatory hormones were measured simultaneously when the blood glucose was less than 50 mg/dL.

RESULTS:

Of 224,125 children seen in the ED during the study, 160 (1:1400) were documented to have hypoglycemia not caused by a previously known condition. Eighty-five (53%) of the 160 hypoglycemic subjects underwent a diagnostic evaluation. Seventeen (20%) of the 85 were classified as having a high-risk disorder causing hypoglycemia, whereas 63 (74%) had a low-risk disorder. Seventy-five patients (47%) did not undergo a diagnostic evaluation during the ED visit or hospital admission.

CONCLUSIONS:

Hypoglycemia of unknown etiology occurs in 1:1400 (0.07%) children who attended the ED during the study. Assuming that none of the children who failed to undergo a diagnostic evaluation had a high-risk disorder, 10.6% of the subjects with hypoglycemia were found to have a high-risk disorder. Because of the increased incidence of high-risk disorders causing hypoglycemia and the long-term health risk associated with hypoglycemia, we recommend that all children with hypoglycemia of unknown etiology have a critical blood sample drawn at the time of hypoglycemia (blood glucose <50 mg/dL) or be admitted for a diagnostic evaluation.

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