Hypoglycemia refers to a clinical syndrome caused by various metabolic and endocrine diseases, leading to blood glucose levels dropping below the physiological lower limit (whole blood glucose below 2.24 mmol/L or 40 mg/dl) and accompanied by a series of clinical symptoms. Acute hypoglycemic episodes are one of the pediatric emergencies, and infants and young children may experience convulsions. Repeated episodes can result in persistent brain

1. Insufficient exogenous glucose sources: or absorption disorders, chronic inadequate food intake, chronic diarrhea, malabsorption syndrome, severe liver diseases such as acute or chronic hepatitis, Reye's syndrome.
2. Insufficient endogenous glucose sources: such as various congenital liver enzyme deficiencies, including glycogen storage diseases types I and III (deficiency of glucose-6-phosphatase and amylo-1,6-glucosidase, respectively), impaired liver glycogenolysis, preventing conversion to glucose. Other examples include glycogen synthase deficiency, galactose-1-phosphate uridyltransferase deficiency (galactosemia), and fructose-1,6-bisphosphatase deficiency. These conditions often manifest hypoglycemic symptoms within the first 6 months of life.
3. Excessive insulin secretion: such as pancreatic β-cell hyperplasia, pancreatic β-cell {|swelling of eyelid|} tumors. Occasionally seen with excessive insulin administration.
4. Deficiency of counter-regulatory hormones: such as anterior pituitary, thyroid, or adrenal cortex insufficiency.
5. Ketotic hypoglycemia: {|disease cause|} unknown, often triggered by infections, vomiting, or fasting, accompanied by positive urinary ketones.

bubble_chart Clinical Manifestations

The symptoms of hypoglycemia are mainly caused by central nervous system dysfunction due to brain glucose deficiency and manifestations of sympathetic nervous system excitation with excessive adrenaline secretion. Symptoms include weakness, confusion, drowsiness, and in severe cases, unconsciousness, while infants and young children may experience convulsions. Other signs include pale complexion, sweating, increased heart rate, abdominal discomfort, nausea, vomiting, low body temperature, and hunger. These symptoms often occur in the early morning on an empty stomach and may be preceded by insufficient dinner the night before. Such symptoms can improve immediately after consuming sugar water or receiving glucose infusion. However, if hypoglycemia persists for too long, recovery may be delayed.

Blood sugar decreases, often <2.2 mmol/L (40 mg/dl); urine ketones are often positive.

bubble_chart Diagnosis

1. Clinical manifestations of hypoglycemia;
2. blood glucose<2.2mmol/L(40mg/dl)；
3. Symptoms improve after glucose supplementation.

bubble_chart Treatment Measures

The treatment of hypoglycemia itself is to rapidly restore blood sugar levels and alleviate symptoms to prevent organic injury to the central nervous system; and treatment should be given according to the disease cause.

1. For mild cases with clear consciousness, oral sugar-containing beverages can be administered. If oral administration is not possible, 25–50% glucose (0.5–1.0 g/kg) can be given intravenously, followed by a 10–15% solution via intravenous drip, with the drip rate gradually slowed. Blood sugar and urine sugar levels should be monitored, and generally, restoring blood sugar to 2.2–6.7 mmol/L (40–120 mg/dl) is sufficient. Avoid excessively high blood sugar or glycosuria.
2. If glucose supplementation is ineffective, corticosteroids such as hydrocortisone 5 mg/(kg·d) or prednisone 2 mg/(kg·d) can be added. Glucagon 30–50 μg/kg (maximum dose 1 mg) can also be administered intramuscularly once.
3. Treatment should be given according to the disease cause.
4. Daily attention to diet and avoidance of hunger can help prevent recurrence.

bubble_chart Differentiation

Infants and young children with convulsions should be distinguished from afebrile convulsions caused by other disease causes (such as hypocalcemic convulsions). If accompanied by infection, they should be differentiated from infectious toxic encephalopathy or central nervous system infections. Disease cause analysis should be conducted based on medical history, physical examination, and necessary laboratory tests.