Abstract
Low blood glucose is a dangerous violation of homeostasis, especially for infants, children and adolescents, in whom hypoglycemia is often observed, which is explained by immaturity and insufficient efficiency of adaptation reactions, primarily imperfection of hormonal regulators and instability of enzyme systems of glucose metabolism and alternative energy sources, in the form of free fatty acids, ketones, lactate, etc. The special danger of hypoglycemia in children is that glucose, although not single, but a priority source of energy for the nervous structures, therefore the lack of glucose leads to a delay in intellectual development and even to brain damage. At the same time, the lack of stability and clarity of reactions from the central nervous system, somatic and autonomic divisions of the nervous systems characteristic of these age groups, makes it extremely difficult to recognize the hypoglycemic syndrome (HS), and the etiological and pathogenetic diversity of the HS makes its clarifying diagnosis an extremely difficult task. In this regard, the issues of prevention, timely diagnosis, urgent and subsequent therapy of hypoglycemia in newborns, children and adolescents are very relevant. Fulfilled critical analysis of thematic literature over many years, as well as analysis own clinical and research experience. The article discusses the typology of HS from the standpoint of the causes and mechanisms of development, establishes anamnestic and obstetric-gynecological features of the course of pregnancy and childbirth, which predispose to hypoglycemia, clarifies the anthropological and clinical stigmas of HS in the fetus and newborn, which suggests the possibility of hypoglycemia in a child, shows the features clinical manifestations of HS in children of different ages. For clinical practice, an etiological and pathogenetic classification of HS, an algorithm for the treatment of hypoglycemic coma (HC), a scheme for the pathogenetic diagnosis of HS is proposed. Hypoglycemia in infants, children and adolescents is a common syndrome that poses a great danger to the health and development of the child and requires timely and qualified assistance.
Highlights
One of the largest sections of human pathology is made up of diseases and syndromes of adaptation, or rather misadaptation
functional hunger hypoglycemia (FHH) is especially typical for infants and children, which is explained by the insufficient maturity of the control mechanisms of homeostasis [6, 7]
Even not very deep, but prolonged, especially chronic hypoglycemia causes or intensifies numerous functional, biochemical and anatomical and morphological changes and disorders - vegetative dystonia, neurasthenia, hyperketonemia and ketoacidosis, hyperuricemia, hepatitis, in the form of fatty liver infiltration, hepatomegaly and increasing liver enzymes [3,4,5, 11, 20]. It is precisely the age groups considered in this article that are especially susceptible to adverse long-term consequences of chronic hypoglycemia, in the form of a delay in intellectual and physical development, and various forms of deviant behavior [1, 2, 8]
Summary
One of the largest sections of human pathology is made up of diseases and syndromes of adaptation, or rather misadaptation. Misadaptation can form at the level of organs and individual systems, which inadequately respond to the normal adaptive signals of systemic regulators [1]. A common form of inadequate metabolic adaptation is hypoglycemia - a decrease in blood glucose levels below the physiological minimum. This is the so-called functional hypoglycemia, along with which there are many other etiological and pathogenetic variants of hypoglycemic syndrome (HS). Many of these options are relevant, sometimes selectively relevant for infants, children and adolescents [2,3,4,5]
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