Management of Hypoglycemia in Pediatric Patients

Definition and Recognition

The American Diabetes Association defines hypoglycemia in pediatric patients as blood glucose <70 mg/dL, with severe hypoglycemia characterized by altered consciousness requiring assistance 1
Symptoms of hypoglycemia vary by age and can include adrenergic symptoms such as sweating, pallor, palpitations, tremors, and neuroglycopenic symptoms such as headache, behavior changes, confusion, drowsiness 2
Infants and young children have limited ability to detect and communicate symptoms, necessitating more frequent monitoring 1

For mild hypoglycemia, the American College of Endocrinology recommends administering 15g of rapidly absorbed carbohydrate (10g for younger children) 2, 1
For mild hypoglycemia, blood glucose should be rechecked after 15 minutes 1
For moderate hypoglycemia, the American Diabetes Association recommends administering 20-30g of glucose orally and targeting restoration of blood glucose to >80 mg/dL 2
In hospital settings, intravenous glucose should be administered for severe hypoglycemia 1
A glucagon dose of 30 mcg/kg subcutaneously (maximum 1mg) will increase blood glucose within 5-15 minutes 3

For critically ill children, the Society of Critical Care Medicine recommends checking blood sugar levels in every septic patient and aiming to keep blood glucose >70 mg/dL (>4 mmol/L) by providing glucose calorie source 4
For critically ill children, the target blood glucose range of 140-200 mg/dL is recommended 5
For diabetic children, the American Diabetes Association recommends frequent blood glucose monitoring, especially around exercise, and maintaining pre-exercise blood glucose between 90-250 mg/dL 1

For severe cases requiring hospital management, vital signs should be monitored hourly (heart rate, respiratory rate, blood pressure, neurologic status) 3
For severe cases requiring hospital management, fluid input and output should be tracked, and capillary glucose should be monitored hourly 3
For severe cases requiring hospital management, laboratory tests (electrolytes, blood glucose) should be repeated every 2-4 hours 3

At follow-up visits, the frequency of hypoglycemia and awareness should be assessed 1