Endocrine Abstracts

Introduction: Hypoglycaemia is a common paediatric medical emergency, hence prompt treatment with appropriate investigations of causes is essential.

Aims: 1) Re-audit investigations sent for children with hypoglycaemia after introduction of “Hypo-packs” from previous audit; (2) To improve awareness of local guidelines to unify clinical practice; (3) Review “Hypo-packs” and consider other improvements.

Methods: A retrospective audit of investigations taken in hypoglycaemic patients over 20 months using clinical notes after the introduction of hypoglycaemia packs to assess completion of hypoglycaemia screens.

Results: Over a 20-month period (May 2018–Dec 2019), 30 patients were coded as hypoglycaemic. Demographics: 19/30=Female; Average age=4.5 years (1 month–14 years); 14 were excluded (8 known diabetic patients, 1 known metabolic condition, 4 no documented hypoglycaemia, 1 referral with no hypoglycaemia in department). Of 16 remaining children - 7/16 had blood glucose < 2.6 at/during admission; 5/7 had a hypoglycaemia screen. 0/7 patients had complete investigations as per our local guidelines. Most commonly forgotten tests were 3-betahydroxybutrate and ketones. Final diagnoses included: 3/7 gastroenteritis, 1/7 refusal to eat, 1/7 viral infection with vomiting, 1/7 unknown diagnosis (BM 2.1), 1/7 adrenal insufficiency.

Conclusions: Despite the introduction of “Hypo packs”, 0% of our patients had complete hypoglycaemia screens performed. The team felt that although the packs were useful they were difficult to find, not re-filled and not clear enough.

Changes made after re-audit:

• Hypoglycaemia lanyard cards have been given paediatric trainees to attach to their access badges/smart cards.

• “Hypo packs” changed to more clearly show which tests and which blood bottles are required (Table 1)

• Order sets being created on our online ordering system

• Responsibility of the last user of the “Hypo pack” to replenish