Definition

• Neonate < 40 mg/dl
• 1 mo – puberty < 50 mg/dl
• Adult < 60 mg/dl

Treatment – Rule of 50

• Neonate (up to 6 mo or so): D10 x  5ml/kg
• Infant – preschool (<50kg): D25 x 2 ml/kg
• Child – adult : D50 x 1 ml/kg
• Note – dangerous to give D10 bolus outside of neonatal period – too much hypotonic fluid, D10 NS would be ok

DDx

• Sepsis, toxic ingestion (BBlocker, Antihyperglycemic, Alcohol, salicylates), poor intake (long vomiting illness), Inborn errors, CAH, GH deficiency, glycogen storage disease, improper formula mixing, liver failure

Workup

• Parents should have newborn screen results by 1 week
• AMS/Hypoglycemia w/u for Inborn Errors
  • Glucose < 50
  • Chemistry – AGMA
  • Ammonia (>200 abnormal)
  • LFTs
  • Urine ketones
  • Grab extra green and red on ice to allow for other labs to be run down the line

Management

• Treat hypoglycemia
• Get labs and urine
• If concern for IEM, stop PO intake
• Consult regarding need for adjuncts, possibly dialysis etc