Introduction: Ketotic hypoglycaemia is not an unusual presentation in preschool children particularly following gastroenteritis. Non-ketotic hypoglycaemia in a child is uncommon and could be due to endocrine or metabolic disorders.
Case report: Presentation: 4-year-old presented with fainting episode and hypoglycaemia as first episode. She was managed by the ambulance crew with oral glucose. Weeks later present to emergency department with non ketotic hypoglycaemia, associated with a mild viral respiratory illness. Hypoglycaemia screen was insufficient but not noticed before discharge. Treated with intravenous glucose and discharged home with a glucose meter and Dextrose tablets. She was admitted to ward following the concern from school about frequent hypoglycaemia around 0930 h at school. In the ward the patient continued to have hypoglycaemia mainly at late night or early morning she was on milk free diet, inhalers, antireflux, medications, emollients and antihistamines.
Investigations: Review of the blood glucose meter showed a trend of hypoglycaemia on weekday morning in school. No blood glucose readings on school holidays or weekends. day 3 of admission Blood glucose 1.8 mmol/l, ketones 0.2 mmol/l.
Background: Preterm, no hypoglycaemia concerns in neonatal period. In infancy frequent inpatient and outpatient for gastroesophageal reflux, faltering growth, food aversion, required nasal gastric tube feeding between 4 and 8 months of age She had neonatal follow up till 2 years of age. Recent outpatient review for co-ordination concerns and has been under follow up with gastroenterology ,respiratory and allergy clinic and awaiting psychologist referral for night terrors and urology referral Further results indicated the presence of exogenous insulin administration with low C-peptide. Further enquiry unravelled there was insulin accessible at home
Lessons learnt: Detail of chronology of events including the pattern of the time of hypoglycaemic events.
Detailed family history including medications available in the home and parents profession.
Significance of having single paediatrician and communicate with other professionals involved in the care of the child
Discharge letter should include blood sugar monitoring plan, hypoglycaemia treatment plan ,care plan for school and early follow up in the clinic.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes