A syndrome caused by various factors leading to abnormally low blood glucose concentration. Generally, a plasma glucose concentration <2.8 mmol/L or whole blood glucose <2.5 mmol/L is considered hypoglycemia. The diagnostic criteria for hypoglycemia in children are 1.11 mmol/L lower than those for adults.

bubble_chart Etiology

The main causes of disease include:

(1) Fasting hypoglycemia: seen in

1. Excessive glucose utilization:

(1) Hyperinsulinemia: insulinoma; newborns of obese-type diabetic mothers (mother has hyperinsulinemia); drugs (such as excessive use of insulin, sulfonylurea hypoglycemic agents, salicylates, propranolol, disopyramide, monoamine oxidase inhibitors), insulin autoimmune hypoglycemia.

(2) Tumors: such as large mesenchymal tumors, primary liver cancer, gastrointestinal tumors, and lymph fleshy tumors.

2. Insufficient glucose production:

(1) Endocrine diseases: hypopituitarism; adrenal cortex hypofunction; hypothyroidism, etc.

(2) Glycogen storage disease with abdominal mass.

(3) Severe liver disease and hepatic congestion.

(4) Advanced stage kidney disease.

(5) Galactosemia (due to deficiency of galactose-1-phosphate uridyl transferase, galactose cannot be converted to glucose).

(6) Others: chronic alcoholism (inhibits gluconeogenesis); sepsis; starvation; cachexia; strenuous exercise, etc.

(2) Postprandial (reactive) hypoglycemia: seen in

1. Functional hypoglycemia (emotional instability and neuroticism, more common in middle-aged women).

2. Nourishment-induced hyperinsulinism: such as dumping syndrome after gastrectomy; post-pyloroplasty and gastrojejunostomy.

3. Idiopathic spontaneous hypoglycemia in children.

4. Mild early-stage diabetes (delayed insulin peak).

bubble_chart Diagnosis

1. History, Symptoms, and Signs:

Depend on the speed of hypoglycemia, individual differences, age, gender (females have stronger tolerance), and the primary disease.

1. Acute hypoglycemia or cases with a short course present with sympathetic excitation symptoms, such as agitation, hunger, weakness, sweating, tachycardia, elevated systolic blood pressure, decreased diastolic blood pressure, tremor, transient blackout, impaired consciousness, and even unconsciousness.

2. Subacute or slow declines in blood sugar manifest as cerebral symptoms, which vary widely, but the same patient often exhibits the same type of symptoms with each episode. Most patients show symptoms of the cerebral cortex and/or cerebellum, such as headache, dizziness, anxiety, irritability, drowsiness, distractibility, disorientation, tremor, grand mal or petit mal seizures, personality changes (crying, shouting, tantrums, cursing), bizarre behavior, ataxia, etc., eventually leading to stupor and unconsciousness. Long-term severe hypoglycemia can cause permanent brain damage.

1. Blood glucose during an episode <2.8mmol/L(50mg/dl)，注射葡萄糖後症狀緩解。 2.不典型病例可測飢餓16小時血糖3次，作過篩試驗，如＞3.9mmol/L(70mg/dl)可排除空腹低血糖，如<2. 22mmol/L(40mg/dl)肯定診斷；

2.22–3.9 mmol/L (40–70 mg/dl) is suggestive of hypoglycemia; continuous fasting for up to 72 hours with exercise until hypoglycemic episodes occur.

3. Differential Diagnosis:

It should be determined whether the hypoglycemia is organic or functional and its disease cause. The most common clinical order of hypoglycemia is functional, insulinoma, and early mild diabetes. Organic cases are mostly fasting hypoglycemia, with longer episodes (mostly >30 min), and are often intractable, progressive, and rarely self-resolving. Functional cases often present with symptoms of autonomic instability, occurring 1–4 hours after meals, with each episode lasting <30 min, intermittent and non-progressive, and may resolve spontaneously.

bubble_chart Treatment Measures

1. Emergency Treatment:

For mild cases, quickly provide sugary foods or drinks. For those who cannot take oral intake or have severe symptoms, immediately administer an intravenous injection of 50% glucose (40ml), followed by a drip of 5-10% glucose. Patients who show no significant response to glucose supplementation may have: ① prolonged hypoglycemia; ② hypoglycemia accompanied by fever; ③ hypoglycemia due to endocrine dysfunction. In such cases, larger amounts of glucose should be supplemented, along with 100–200mg of hydrocortisone mixed with glucose for drip infusion. Glucagon may also be administered via intramuscular injection or intravenous push.

2. Disease Cause Treatment:

For functional and reactive hypoglycemia, a low-sugar, high-fat, high-protein diet is recommended, with frequent small meals, along with small doses of sedatives and vagus nerve inhibitors. Hypoglycemia caused by tumors or other factors requires corresponding disease cause treatment.