Contributor: Taylor Lynch, MD Educational Pearls: When it comes to hypoglycemia, the age dictates possible causes Neonate: Hormonal deficiency Congenital Adrenal Hyperplasia (21-hydroxylase deficiency, 11β-hydroxylase deficiency) Primary or Secondary Adrenal Insufficiency leading to cortisol deficiency  Hypopituitarism Inborn errors of metabolism Systemic infection (Under 30 days old should trigger a full infectious workup) Toddler Accidental ingestions Sulfonylureas such as glipizide or glyburide Older children Addison’s Disease (Hypocortisolism) Accidential or intentional ingestions Exogenous insulin How is it diagnosed? Child or infant Glucose Newborn Glucose Treatment Awake: oral glucose Altered: IV glucose Rule of 50’s. The dose you give times the concentration should equal 50 Neonate to 2 months get 5 mg/kg of D10W (5*10=50) 2 months to 8 years old get 2 mg/kg of D25W (2*25=50) Over 8 gets 1 mg/kg of D50W (1*50=50) Bonus fact: Rough estimate of weight for a child is 2*patients age plus 8 Recheck sugar every 15 minutes If they stay hypoglycemic give another bolus and consider starting a drip at 1.5 maintenance dose of D10NS. If you don’t have an IV you can consider glucagon at 0.03 mg/kg IM, although you might be better off trying glucose gel buccally. If standard therapy still fails you can give hydrocortisone 25 mg IV for neonates and infants 50 mg IV for toddlers and smaller school aged children 100 mg for anyone older than that How do you test for exogenous insulin? Check a c-peptide which would be low if a patient is taking exogenous insulin References Lang, T. F., & Hussain, K. (2014). Pediatric hypoglycemia. Advances in clinical chemistry, 63, 211–245. https://doi.org/10.1016/b978-0-12-800094-6.00006-6 Lee, S. C., Baranowski, E. S., Sakremath, R., Saraff, V., & Mohamed, Z. (2023). Hypoglycaemia in adrenal insufficiency. Frontiers in endocrinology, 14, 1198519. https://doi.org/10.3389/fendo.2023.1198519 Thompson-Branch, A., & Havranek, T. (2017). Neonatal Hypoglycemia. Pediatrics in review, 38(4), 147–157. https://doi.org/10.1542/pir.2016-0063 Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce, MS1 & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/