Case 4: Hypoglycemia after Nissen Fundoplication in a 7-month-old Girl

Abstract

1. Mansa Krishnamurthy, MD* 2. Belinda Chandra, MD* 3. Maria Henwood-Finley, DO† 1. *Department of Pediatrics, 2. †Section of Pediatric Endocrinology, Brody School of Medicine, Greenville, NC A 7-month-old girl underwent a Nissen fundoplication for severe gastroesophageal reflux. On postoperative day 5, she was found to be sweating profusely, and her hands and feet felt moist. Her blood glucose level at the time was 32 mg/dL (1.8 mmol/L). Serial measurements of blood glucose levels before and after meals over a 48-hour period demonstrated preprandial hypoglycemia (blood glucose level, 32 mg/dL [1.8 mmol/L]) and postprandial hyperglycemia (blood glucose level, 233 mg/dL [12.9 mmol/L]) (Fig 1). When hypoglycemia recurred, a critical sample was collected to rule out possible etiologies of hypoglycemia, including congenital hyperinsulinism, growth hormone deficiency, cortisol deficiency, fatty acid oxidation defects, organic acid disorders, and iatrogenic causes. Figure 1. Preprandial and postprandial blood glucose levels. Our patient’s pattern of postprandial hyperglycemia followed by hypoglycemia suggested dumping syndrome. The diagnosis was confirmed by laboratory testing, which showed a rise in insulin levels from 2.4 μIU/mL (16.7 pmol/L) at baseline to 13.7 μIU/mL (95.2 pmol/L) 30 minutes after a feeding followed by a decline to 2.3 μIU/mL (16.0 pmol/L) 90 minutes after a feeding while her postprandial glucose readings increased to 190 mg/dL (10.5 mmol/L) …