Management of hypoglycaemia in a child

Consult expert advice:

• establish the diagnosis with an immediate finger prick glucose test

Glucose 10-20 g is given by mouth either in liquid form, eg milk 200 mL, or as granulated sugar (2 teaspoons) or sugar lumps

• if necessary, this may be repeated following 10-15 minutes
• further food is required to prevent recurrence of hypoglycaemia.

Hypoglycaemia which causes unconsciousness or fitting is an emergency

• if sugar cannot be given by mouth, glucagon can be given by injection
  • a child aged under 8 years or of bodyweight under 25 kg should be given 500 micrograms
• in order to restor liver function then carbohydrates should be given as soon as possible
• glucagon may be issued to parents or carers of insulin-treated children for emergency use in hypoglycaemic attacks
  • it is often advisable to prescribe on an 'if necessary' basis to hospitalised insulin-treated children, so that it may be given rapidly by the nurses during a hypoglycaemic emergency
  • if not effective in 10 minutes, IV glucose should be given.

Alternatively, 2-5 mL/kg of glucose IV infusion 10% (200-500 mg/kg of glucose) may be given IV into a large vein, through a large-gauge needle

• this concentration is irritant, especially if extravasation occurs
• glucose IV infusion 50% is not recommended, as it is very viscous and hypertonic.
• patient should be monitored closely, particularly in the case of an overdose with a long-acting insulin because further administration of glucose may be required.

Neonatal hypoglycaemia

• treated with glucose IV infusion 10% given at a rate of 5 mL/kg/hour
  • initial dose of 2.5 mL/kg over five minutes may be required if hypoglycaemia is severe enough to cause loss of consciousness, or fitting
• miild asymptomatic persistent hypoglycaemia may respond to a single dose of glucagon
  • dose is 20 mcg per kg
• glucagon has also been used in the short-term management of endogenous hyperinsulinism.