CHILDHOOD HYPOGLYCEMIA IN AN URBAN EMERGENCY DEPARTMENT - EPIDEMIOLOGY AND A DIAGNOSTIC-APPROACH TO THE PROBLEM

Objective: To 1) determine the prevalence of hypoglycemia in childhood in a pediatric emergency department (ED), 2) determine epidemiology o f idiopathic ketotic hypoglycemia (IKH), 3) determine diagnostic yield of the workup of hypoglycemia, and 4) review a diagnostic approach to hypoglycemia. Setting: Urban pediatric ED of a tertiary level childre n's hospital Methods: Retrospective review of all medical records with a primary or secondary diagnosis of hypoglycemia (ICD-9 code 251.2) s een at the ED between 1/92 and 8/95, Results: Thirty-one patients were identified. Mean blood glucose was 34.2 mg/dl, Prevalence of hypoglyc emia among population seeking care in our ED was 6.54/100,000 visits. Eighteen patients were diagnosed with IKH for a prevalence of 3.9/100, 000, IKH demographics were: mean age 27.7 months; 12 males, 6 females; 8 white, 9 black, and 1 not available, The weights of five patients w ere < 25th percentile. Fourteen of the 18 TW patients had hormone stud ies done insulin [cost $40], growth hormone [$69], cortisol [$54]. All 14 had appropriately suppressed insulin levels (< 5 mu U/ml) and high cortisol levels > 22 mu g/ml. Thirteen of the 14 had normal or high g rowth hormone (GH) levels (0.7-6 ng/ml), Four IKH patients had urine d rug screens ($280); all were negative, Although no IKH patient was feb rile, six had sepsis workups ($380); all were negative, Urine ketones mere positive in 15 of the 15 tested (> 3+ in eight patients). Mean an ion,gap was 20 (range: 16-30). Eight of the 18 IKH patients were disch arged from the ED after return to normal status. Conclusions IKH is th e most common cause of hypoglycemia in children beyond the infancy per iod. In its typical presentation (previously healthy one- to five-year -old, with normal growth and development, who presents with a first ep isode of symptomatic fasting hypoglycemia and appropriate degree of ke tonuria, without hepatomegaly, and with resolution of symptoms on admi nistration of glucose), an extensive and overzealous workup, for endoc rinopathy or inborn error of metabolism is not necessary.