PICU Doc On Call Approach to Hypoglycemia in the PICU
Dec 28, 2025
A riveting discussion focuses on a 9-month-old with hypoglycemia and seizures, delving into glucose metabolism fundamentals. Learn about various causes of hypoglycemia, from metabolic disorders to endocrine issues. The hosts expertly highlight diazoxide as a key treatment for hyperinsulinemic hypoglycemia while addressing its side effects. Insightful tips on quick diagnosis and personalized treatment underscore the importance of prompt intervention in pediatric care, all wrapped in a captivating case study that brings clinical scenarios to life.
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Seizures From Correctable Hypoglycemia
- A previously healthy seven-month-old had refractory seizures that were due to hypoglycemia with glucose 32 mg/dL.
- Seizures stopped after a D10W bolus and glucose rose to 75 mg/dL, prompting PICU admission for workup and monitoring.
Two Hepatic Pathways Keep Glucose Up
- Glycogenolysis and gluconeogenesis are the two core hepatic processes that raise serum glucose during fasting.
- Counterregulatory hormones (glucagon, cortisol, GH, epinephrine) stimulate gluconeogenesis, glycogenolysis, lipolysis, and ketogenesis.
Low Ketones Narrow The Differential
- Low ketones with hypoglycemia point to either excess insulin or a fatty acid oxidation defect.
- Elevated insulin suppresses ketogenesis, so low beta-hydroxybutyrate favors hyperinsulinemic states.