Hypoglycemia

Hypoglycemia is increasingly recognized as a significant risk for morbidity and mortality in critically ill and injured children, especially with the recent focus on “tight glucose control” in the pediatric intensive care unit. The lack of adequate energy support in critically ill infants and children with low metabolic reserves is a significant and often underappreciated risk factor, though a variety of other etiologies may be involved. There is no one blood glucose value that defines “hypoglycemia.” Rather, hypoglycemia is considered to represent a spectrum of clinical signs and symptoms that occur within a relatively broad range of blood glucose values that resolve when treated with exogenous glucose. Hypoglycemia is clinically important, as glucose is the most important energy fuel of the body, especially for the brain. As such, glucose homeostasis is normally tightly regulated. Treatment of the underlying disease, early enteral nutrition, basic glucose infusion, avoidance of excessive control of transient stress hyperglycemia may be all important factors to maintain glucose homeostasis and the lowest risk of occurrence of hypoglycemia for the individual patient.