Emergency treatment of severe hypoglycaemia

SPEG (Scottish Paediatric Endocrine Group)

If the child does not tolerate oral glucose or shows signs of severe hypoglycaemia (reduced conscious level) give intravenous glucose 200 mg per kg body weight (10% dextrose, 2mL per kg) over 3 minutes.

If the response is poor, give 100 mg hydrocortisone by intravenous injection.

Continue with a glucose infusion iv at 10 mg per kg per minute (6 mL/kg per hour of 10% dextrose).

Check blood glucose using the ward meter after 5 min and adjust the glucose infusion to maintain a blood glucose of 5-8 mmol/L and no higher.

If there is no improvement in conscious level after normal blood glucose is restored, an alternative explanation should be sought.

It is not necessary to discontinue the test and, if possible, continue blood sampling.

IMPORTANT
50% dextrose should NEVER be used in the resuscitation of a child with severe hypoglycaemia following an endocrine test.

After the test

  • Once the test is completed, give a sweet drink and make sure the child has had something to eat.
  • Keep the child under observation for at least 1 hour after the meal has been consumed.
  • Keep the cannula in position until lunch has been eaten and the child has not vomited.
  • Ensure that a blood glucose measured on the ward meter reads greater than 4 mmol/L before discharge.
  • If there is any doubt about the child's wellbeing, keep him/her in the ward overnight for observation.

Interpretation of results

If Growth Hormone is greater than 6.7 microgram/l at any point (including the baseline measurement) this indicates there is a normal GH response and rules out growth hormone deficiency.

If Growth Hormone is less than 6.7 micrograms/l in the presence of adequate hypoglycaemia (blood glucose less than 2.2mmol/l or at least a 50% drop in plasma glucose, this indicates growth hormone deficiency.

Hypoglycaemia to this degree should also cause an increase in the plasma cortisol. Please check with local laboratories for reference ranges.