What Are the Symptoms of Hypoglycemia in Children?

Hypoglycemia in children means that the blood glucose concentration caused by different reasons is lower than normal. The blood glucose drops to the lowest point at 1 to 2 hours after birth, and then gradually rises. The plasma glucose should be> 2.8mmol / L (> 50mg / dl) in 72 hours. Hypoglycemia is <2.2mmol / L (<40mg / dl) in children, and fasting blood glucose <2.8mmol / L (<50mg / dl) in older infants and children is hypoglycemia. Birth infants should start active treatment when their blood glucose is <2.24mmol / L (<40mg / dl). Hypoglycemia can cause irreversible damage to the brain and affect brain function.

Causes of hypoglycemia in children

Glucose is an important part of human energy metabolism. Glucose is almost all the oxygen metabolism of the brain of the newborn. 60% to 80% of the glucose produced by the liver of the adult is used by the brain, and 80% to 100% of the newborn is used by the brain. At a monthly weight of 3.5 kg, the brain weight is about 450 g, and every 100 g of brain tissue uses 4 to 5 mg of glucose per minute, which is about 20 mg / min. Babies and children produce 5 to 8 mg / kg of glucose per minute. The liver produces glucose at a rate of 5 7mg / kg per minute, so all the glucose produced by the liver is used by the brain. The endogenous glucose production is completely positively related to the growth of people weighing less than 40kg and the brain. Because the brain develops fastest in the first year after birth, The utilization of glucose is the largest, and the degree of infant brain damage is also the most severe when hypoglycemia occurs within the first year of life. The younger the age of the baby, the greater the danger of hypoglycemia, and the more damage to brain development and brain function Importantly, due to the limited storage of liver glycogen during hypoglycemia in newborns, in order to maintain brain cell energy, components of brain tissue such as structural proteins, myelin, etc. are cleaved to produce amino acids and ketone bodies as brain metabolism The brain tissue is damaged. Although the ability of the newborn brain to use ketone bodies is high, the amount of ketone bodies produced is extremely limited. In particular, it inhibits the breakdown of glycogen and fat during high insulin and hypoglycemia. Therefore, the damage to the brain is more serious, the brain cell membrane function is completely destroyed and the permanent brain damage is caused, the gray matter of the brain is atrophied, the white matter myelin sheath is reduced, and the cerebral cortex is also atrophied.

1. Insufficient glucose matrix in the neonatal period

The main reason for the high incidence of hypoglycemia in preterm infants and low birth weight infants is due to insufficient reserves of liver glycogen and muscle glycogen, and body fat has become the main source of energy supply. Because infants are small, especially premature infants and immature infants Or impaired placental nutritional supply and inadequate development of enzymes required for gluconeogenesis are the main causes of hypoglycemia.

2. Neonatal hyperinsulinemia

Babies with diabetic mothers may have transient hyperinsulinemia. The incidence of gestational diabetes is about 2%. Such babies have sufficient glycogen, protein and fat, and the newborns of diabetic mothers have hyperinsulinemia and pancreas after birth. Glycogen secretion is reduced, which is different from normal newborns. At the same time, due to sympathetic nerve excitement, the adrenaline of the adrenal medulla is depleted, so the amount of endogenous glucose is reduced, which is prone to hypoglycemia.

3. Hyperinsulinemia in infants and children

Hyperinsulinemia can occur at any age, and neonatal hyperinsulinemia may not be caused by a diabetic mother.

4. Deficiency of endocrine hormones

Cortisol and growth hormone are the main hormones that antagonize insulin, and are important factors to maintain the stability of blood sugar in the body. Those with simple growth hormone deficiency or reduced total pituitary function, and / or insufficient ACTH-glucocorticoid, make glycogen Enzyme activity and matrix production are reduced, gluconeogenesis disorders, hypoglycemia on fasting, hypoglycemia such as Addison's disease and adrenocortical white matter disease can also have hypoglycemia. In addition, in patients with a lack of adrenal medulla, when blood glucose decreases, Secretion does not increase, can not promote the breakdown of glycogen, so that blood sugar can not rise, often stay at low levels, hypoglycemia also causes hypoglycemia.

5. Restriction of matrix

Ketogenic hypoglycemia; maple syrup.

6. Glycogen storage disease

In glycogen storage disease, hypoglycemia occurs in type , type , type and type O. Among them, type glucose-6-phosphatase deficiency is more common.

7.Glycogenous diseases

Impairment of gluconeogenesis can cause hypoglycemia.

8. Defects of fatty acid oxidation

Fatty acid oxidation provides a substrate for gluconeogenesis to the role of blood glucose. Fasting hypoglycemia can occur if fatty acid metabolism defects are caused by congenital or drugs. Congenital deficiency of various fat metabolism enzymes can cause carnitine deficiency or fatty acid metabolism defects. Fat metabolism is stagnated, ketone bodies cannot be produced, hypoglycemia, liver enlargement, decreased muscle tone, and convulsions.

9. Deficiency of other enzymes and other reasons

Galactosemia; Fructose intolerance; Other liver damage; Drug poisoning; Reduced intestinal absorption; Uncontrollable hypoglycemia.

Clinical manifestations of hypoglycemia in children

There are two main types of clinical manifestations of hypoglycemia. One is the consequence of autonomic nervous system excitement and the release of adrenaline, which often appears with a sharp drop in blood glucose; the other is due to a decrease in cerebral glucose utilization, which often slows with blood glucose. Prolonged decline or hypoglycemia.

Mainly manifested in older children. Symptoms caused by autonomic nervous excitement of excessive adrenaline are sweating, trembling, tachycardia, irritability, nervousness, irritation, hunger, nausea and vomiting, due to cerebral glucose utilization Reduced symptoms include headache, visual impairment, fatigue, indifferent expression or depression, restlessness and excitement, speech and thinking disorders, inability to concentrate, blurred consciousness, decreased intelligence, altered personality and behavior, dullness, lethargy, and even loss of consciousness. Coma convulsions and permanent nerve damage.

The symptoms of hypoglycemia in newborns and small infants are not obvious, often ignored, and non-specific. Hypoglycemia in small infants can manifest as cyanosis, apnea, dyspnea, milk rejection, sudden transient myoclonus, and weakness. , Drowsiness and convulsions, body temperature is often abnormal.

Pediatric hypoglycemia

Urine sugar

Children with hypoglycemia, urine glucose positive after meals, may be caused by non-glucose reducing substances, and its properties should be further determined.

2. Urine Ketone Body

Often provide some clues to the diagnosis, but conventional methods can only measure acetoacetic acid and acetone, -hydroxybutyric acid, which accounts for 70% of the ketone body, cannot be detected. It should be noted that when -hydroxybutyric acid significantly increases, The increase may not yet be obvious, and it cannot be wrongly judged as mild ketosis.

3. Plasma glucose, ketone bodies, lactic acid and pyruvate

Systematic determination of these substances in the fasting state helps to understand the correlation between hormones and substances related to sugar balance, and if necessary, simultaneous determination of cortisol and growth hormone.

ECG examination may have tachycardia, low voltage; chest X-ray examination is generally found no abnormalities.

Pediatric hypoglycemia diagnosis

The etiology of hypoglycemia in children is extremely complicated. In order to diagnose in time, in addition to a detailed medical history, the age, time, and condition of hypoglycemia are very important. Newborns are born, especially premature infants, immature infants or children born less than gestational age. Hypoglycemia that occurs within the next week is mostly temporary hypoglycemia in newborns. In neonates with diabetic mothers, hypoglycemia in newborns with small erythrocytosis or small head, large internal organs, and large tongue should be considered for hyperinsulinemia. Taking into account the lack of various enzymes, find the clues of the cause of hypoglycemia from the detailed clinical history and meticulous physical examination, and carry out the necessary examination. Blood glucose, insulin, ketone body, alanine, lactic acid, blood lipid, and uric acid should be taken in time for hypoglycemic episodes as the data for differential diagnosis. If necessary, observe the glucagon stimulation test and input alanine and glycerol. Observing the blood glucose response, when there is no acute hypoglycemia onset, the fasting time can be extended to 24-32 hours to induce hypoglycemia. Endocrine gland function can be diagnosed in time by examining the endocrine gland dysfunction. Finally, the accurate diagnosis of enzyme deficiency must be determined by enzyme activity.

Differential diagnosis of hypoglycemia in children

The disease is caused by a variety of reasons, so it should be thoroughly examined in time, especially to identify islet -cell tumors or hyperplasia and functionally unknown hypoglycemia. Generally, the latter are mostly mild and have only obvious sympathy. Nerve or adrenergic syndrome; the former is a brain nerve with obvious mental symptoms, which can be combined with laboratory and other special examinations to confirm the diagnosis.

1. The possibility of hypoglycemia should be considered in patients with episodic (especially fasting) psycho-neurological disorders, convulsions, behavioral disorders, unconsciousness or coma, especially in patients with diabetes treated with insulin or oral hypoglycemic agents, Check the blood sugar in time. It is worth noting that some patients with hypoglycemia have normal blood sugar at the time of consultation, and have no symptoms of hypoglycemia, and often only show the sequelae of chronic hypoglycemia, such as hemiplegia, dementia, epilepsy, mental disorders, children with significantly lower IQ, etc As a result, it is often misdiagnosed as mental illness, epilepsy or other organic encephalopathy (such as encephalitis). Therefore, it should be distinguished from other diseases of the central nervous system organic disease, such as encephalitis, multiple sclerosis, and cerebrovascular accidents. , Epilepsy, diabetic ketoacidosis coma, diabetic nonketogenic hyperosmolar coma, psychosis, drug poisoning, etc.

2. Hypoglycemia whose symptom excitement is the main manifestation on an empty stomach, several hours after a meal, or after physical activity, should be related to diseases with sympathetic excitement, such as hyperthyroidism, pheochromocytoma, and autonomic dysfunction. Diabetes autonomic neuropathy, menopausal syndrome and other phases are identified.

Pediatric hypoglycemia complications

Frequent tachycardia, visual impairment, language and thinking disorders, blurred consciousness, decreased intelligence, and even consciousness due to loss of consciousness, convulsions and permanent nerve damage; small infants can exhibit apnea, dyspnea and so on.

Pediatric hypoglycemia treatment

First aid measures

(1) Oral glucose or glucose-containing food It is recommended to drink a glass of fruit juice or 3 tablespoons of sugared sugar, a glass of milk can also work. It is recommended that children with insulin therapy carry candy or glucose tablets at all times.

(2) Intravenous bolus glucose Intravenous infusion of 25% to 50% glucose in infants with acute hypoglycemia. Immediately inject intravenously while intramuscularly with glucagon. In some children, significant hyperglycemia and intense insulin secretion can be induced.

(3) Glucagon If glucagon is effective, the clinical symptoms of hypoglycemia are usually relieved within 10 to 25 minutes. If the child does not respond to glucagon within 25 minutes, the second injection is not recommended . The main side effects are nausea and vomiting. The efficacy of glucagon depends mainly on the amount of glycogen stored in the liver. Glucagon has little effect on children with hunger or chronic hypoglycemia.

Symptomatic treatment

(1) Hormone replacement Hypoglycemia caused by lack of glucocorticosteroids, growth hormones or thyroid hormones can be treated with corresponding hormone replacement.

(2) Corticosteroids such as hydrocortisone or prednisone. When the effect is not obvious, switch to glucagon, and need to inject glucose at the same time.

(3) Adrenaline is effective in inhibiting insulin secretion.

(4) Hyperinsulinemia Corticosteroids were started after intravenous glucose first aid. Note that long-term use cannot be stopped suddenly. When the effect of drug treatment is not obvious, a laparotomy is required, and pancreatic adenomas are removed. If there is no pancreatic tumor, 85% to 90% of the pancreatic tissue is removed.

(5) Insulin-secreting islet cell tumors require surgery. A single insulinoma is most commonly seen and can be cured by resection, but tumor localization is difficult and often requires reoperation or partial resection of the pancreas.

(6) Restriction of stimulating substances Due to hypoglycemia induced by ingestion of fructose, galactose or leucine, the treatment method is to limit or prevent the intake of these substances.

(7) Anti - epilepsy Patients with hypoglycemia that seriously damage brain cells and cause secondary epilepsy should be treated with anti-epileptic drugs.

(8) Ketogenic hypoglycemia The urine ketone body should be measured frequently during the period when hypoglycemia does not occur. If the urine ketone body is positive, it indicates that hypoglycemia will occur within a few hours. Sugary drinks can be given in time to prevent hypoglycemia.

(9) Glycogen metabolism disease In addition to high-protein diet, raw corn starch solution can also be taken, taken at meals, before bedtime and at night, can improve the condition.

(10) Maple uricemia Children should limit the content of leucine, isoleucine and valine in their diet. Glucose should be infused every time the infection is prone to hypoglycemia.

(11) Surgical resection Surgical resection is effective for non-insulin-secreting stromal tumors.

3. Stem cell therapy

Stem cells are a class of pluripotent cells with self-replication ability. Under certain conditions, they can differentiate into a variety of functional cells. Therefore, stem cells can be used to treat various cell-damaging diseases. Diabetes is a good example. The islet cells are damaged, so the amount of insulin secreted is insufficient, and the blood sugar continues to rise. If the disease is not controlled in the past, systemic organ dysfunction will occur, and various complications will follow. Stem cells can repair damaged islet cells, restore islet function, make it secrete insulin normally, and then recover from diabetes.

Pediatric hypoglycemia prevention

As parents of children, you must not only be careful during the day, but you cannot relax your vigil at night. Because your child's blood sugar is likely to drop sharply at night, even to a level never seen before.

When a hypoglycemia occurs, first lie quietly without disturbing, and quickly prepare a cup of warm sugar boiling water (about 250 ml) to drink. It is better to have glucose at home. After drinking the sugar water, lie still for about 10 minutes, and the symptoms are alleviated.

Management of hypoglycemic coma:

1. Test blood glucose if possible;

2. The patient is still conscious and can drink sugar water;

3. The patient is in a coma. Relatives and friends can apply honey on the patient's oral mucosa and gums.

4. Get in touch with your doctor at the same time.