Endocrine Abstracts (2019) 65 P214 | DOI: 10.1530/endoabs.65.P214

Hypoglycaemia screen (hypopak) quality improvement audit

Kirsty Spence1, Rachel Beckett2, Gillian Hamilton3, Mohammad Alcheikh4, Emmeline Heffernan2, Noina Abid2, Siobhan O’Sullivan4, Grainne Connolly3 & Margaret McDonnell1


1Regional Endocrine Laboratory, Belfast Health and Social Care Trust, Belfast, UK; 2Paediatric Endocrinology and Diabetes Unit, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK; 3Regional Metabolic Laboratory, Belfast Health and Social Care Trust, Belfast, UK; 4Paediatric Metabolic Unit, Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK


In Northern Ireland hypopaks (contains samples for glucose, lactate, hydroxybutyrate, insulin, growth hormone (GH), cortisol, amino acids, organic acids and acylcarnitines) are used to investigate hypoglycaemia in children. We aimed to assess the appropriateness of hypopak requests, to determine their usefulness in diagnosing endocrine and metabolic conditions and to determine if GH is helpful. Data for hypopaks received between 01 April 17 and 31 March 18 was analysed. Hypopaks with unrecorded glucose or glucose ≥3 mmol/l were excluded. In total 223 hypopaks were received from 210 patients: 51% (113 hypopaks) were from girls; 67% samples came from children <3 years; only 36% (80 hypopaks) had complete results. Of the 113 samples with laboratory glucose <3 mmol/l, 21% had glucose <2 mmol/l with 2.7% having glucose <1 mmol/l. There were 25 samples with detectable insulin when glucose was <3 mmol/l (3 samples were from 1 patient thus 23 patients total). Three samples were taken post dextrose. Eight patients had samples sent during the neonatal period. Seven had no follow-up, the rest attend relevant clinic. Of the 113 samples with lab glucose <3 mmol/l, 82% (n=92) had GH <6.7 ng/ml. Only 20 (18%) showed appropriately raised GH. 5/6 patients with GH <1 ng/ml had congenital abnormalities, the other had gastroenteritis. There were 24 hypopaks for children with glucose <3 mmol/l and cortisol <450 nmol/l. One child had 2 hypopaks thus there were 23 children in total. Of these 14 never had a short synacthen test (SST) performed. Three had inadequate SST, 3 had adequate SST response. On later samples the other 3 children showed adequate cortisol on hypoglycaemia. This audit has shown that only 51% of hypopaks received had glucose <3 mmol/l, 74% had incomplete results and no cases of short stature were detected using GH in hypopaks. We propose to develop guidelines for appropriate requesting of hypopaks and result interpretation.

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