Health & Medical Children & Kid Health

Hypoglycemia in an Infant: Case Challenge

´╗┐Hypoglycemia in an Infant: Case Challenge

Diagnosing and Managing Congenital Hyperinsulinism

Case Presentation

A 6-month-old, previously healthy girl was seen after her parents called emergency medical services (EMS) reporting an episode consistent with a seizure. Her parents said that when they went to wake their daughter in the morning, her eyes were rolling upward, and she had stiffening of her upper extremities; this lasted about 1 minute.

When EMS arrived at the home, the infant had a capillary blood glucose of 22 mg/dL measured by glucose meter. Intravenous (IV) access was obtained, and she was given a 2 mL/kg bolus of 10% dextrose before arriving at the emergency department (ED). An en route recheck of glucose showed improvement to 74 mg/dL. Upon arrival at the ED, the infant's plasma glucose was 46 mg/dL. Continuous IV fluids with dextrose were initiated, and a continued upward titration of the glucose infusion rate was necessary to maintain blood glucose in the desired range, above 70 mg/dL.

The parents reported that since breastfeeding was discontinued 1 month ago, the infant has been very irritable in the morning before her first feeding. Physical exam showed her to be well nourished and apparently healthy. Heart, lung, and abdominal exams were normal.

The patient was admitted and monitored overnight. Electroencephalogram, complete blood count, and electrolytes were normal. Blood glucose remained stable, and she was weaned off fluids the following morning. The infant ate normally, and blood glucose levels obtained prior to feeding were all greater than 60 mg/dL.

Questions answered incorrectly will be highlighted.

What is the most appropriate next step?

The infant can be discharged because her blood glucose is in the normal range

Neurology should be consulted for initiation of antiseizure medication

A more comprehensive diagnostic evaluation should be initiated to determine the cause of the hypoglycemia

A sepsis work-up should be started to rule out an underlying infection

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