Endocrine Abstracts (2018) 58 OC2.1 | DOI: 10.1530/endoabs.58.OC2.1

An audit of hypoglycemia screens in paediatric and neonatal patients in two district general hospitals

Harry Dougherty, Georgina Cameron, Sriparna Kar & Aileen Alston

Epsom and St Helier University Hospitals, London, UK.

Introduction: The thorough investigation and prompt management of hypoglycaemia is crucial in determining the diagnosis and preventing associated morbidity and mortality. Delay in obtaining blood samples during the ‘Golden Hour’ of hypoglycaemia, and sampling incorrectly or insufficiently may result in missed diagnosis and necessitates readmission for a fasting glucose profile. This audit was undertaken to evaluate the successful implementation of hypoglycaemia screens in children and neonates in secondary care setup, against current trust guidelines on the management of Paediatric Hypoglycaemia.

Methods: Retrospective audit of case notes of Children (0–16 years) attending the emergency department, and newborn babies (0–3 days) in SCBU with documented hypoglycaemia (blood glucose <2.6 mmol on glucometer or blood gas measurement) who had blood and urine samples obtained in accordance to recommended hypoglycaemia screening. The aim was to critically evaluate the time lapse from initial recorded hypoglycaemia to samples obtained and the completeness of the investigations carried out. Time scale = four months.

Results: Overall four children and seven newborns had blood and urine samples obtained during hypoglycaemia (n total =11). 67% of the children and 40% of the neonates had samples collected appropriately and sufficiently for analysis. 50% of children, versus 57% of newborns, had samples obtained within the first hour of hypoglycaemia. 100% children, versus only 14% of newborns (n=1) had ketones (point of care, urine or laboratory Beta-hydroxybutyrate) measured during a hypoglycaemic event.

Conclusions: To improve the quality of hypoglycaemia screens in secondary care we have incorporated several measures to benefit clinical practice. Firstly, to educate healthcare professionals on ketotic versus non-ketotic hypoglycaemia, to guide which samples are of the utmost importance to obtain during hypoglycaemia; focusing on diagnosis. Secondly, ensuring availability of point of care Ketone testing and hypoglycaemia blood sampling packs in clinical areas, creating an online hypoglycaemia order set, to assist in the correct ordering and labelling of investigations. Finally, we updated our local paediatric hypoglycaemia guidelines.

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