Etiology and outcome of hypoglycemia in young children: A retrospective cohort study

Objectives: Hypoglycemia is one of the most common presenting complaints at a pediatric emergency department. There are many distinct causes of hypoglycemia, ranging from nutritional insufficiency to infectious origins to metabolic disorders. Full clinical assessment and appropriate investigations can help differentiate the cause of hypoglycemia with subsequent tailored management. All patients with hypoglycemia should have a full clinical assessment together with a hypoglycemia screen if appropriate. This clinical review aims to determine the investigation of hypoglycemia in young children (<6 years) and whether these patients received a subsequent diagnosis and adequate follow-up plans. Material and Methods: The laboratory database searched for all children from 0 to 6 years old, with hypoglycemia defined as plasma glucose (PG) <54.0 mg/dL (or <3.0 mmol/L) from 2013 to 2021 at the Royal Hospital of Children, Glasgow. Cases were reviewed for the biochemistry investigations to determine if they had hypoglycemia screening requested and/or performed the presenting complaint, clinical diagnosis, and subsequent follow-up arrangements. Results: Five hundred and one children were identified with hypoglycemia (PG <54.0 mg/dL) over a 9-year period. Of these patients, 28% (142/501) had a full hypoglycemia screen, 38% had a partial screen, and 34% (166/501) had no additional blood tests related to hypoglycemia screening other than a PG. The cause of hypoglycemia was identified in 15% (77/501), with gastroenteritis being the most common cause. Of those who were hypoglycemic, 48% (240/501) had an ongoing follow-up. Among those with severe hypoglycemia (PG ≤27.0 mg/dL) (86/501), causes were identified in 72% (62/86) and 63% (54/86) of this cohort which was followed up after the first presentation. Conclusion: Screening was not consistently performed for all patients presenting with hypoglycemia. A great portion of patients were not fully investigated or followed up. This could be a result of clinical judgment in the assessment of further investigation for hypoglycemia. However, moderate and severe hypoglycemia still require further investigations, which can potentially lead to long-term consequences if not managed appropriately.