The Incidence and Etiology of Previously Undiagnosed Hypoglycemic Disorders in the Emergency Department.

Abstract

The aim of this study was to determine the incidence and etiology of previously undiagnosed hypoglycemia in children (<18 years of age) seen in a hospital emergency department (ED). A retrospective review of all emergency room visits over a 2-year period was conducted to identify patients younger than 18 years who had hypoglycemia (<50 mg/dL) not associated with a previously known cause. Evaluation of hypoglycemia was conducted during a spontaneous hypoglycemic event or during hypoglycemia induced by a fasting study. Insulin and counter-regulatory hormones were measured simultaneously when the blood glucose was less than 50 mg/dL. Of 224,125 children seen in the ED during the study, 160 (1:1400) were documented to have hypoglycemia not caused by a previously known condition. Eighty-five (53%) of the 160 hypoglycemic subjects underwent a diagnostic evaluation. Seventeen (20%) of the 85 were classified as having a high-risk disorder causing hypoglycemia, whereas 63 (74%) had a low-risk disorder. Seventy-five patients (47%) did not undergo a diagnostic evaluation during the ED visit or hospital admission. Hypoglycemia of unknown etiology occurs in 1:1400 (0.07%) children who attended the ED during the study. Assuming that none of the children who failed to undergo a diagnostic evaluation had a high-risk disorder, 10.6% of the subjects with hypoglycemia were found to have a high-risk disorder. Because of the increased incidence of high-risk disorders causing hypoglycemia and the long-term health risk associated with hypoglycemia, we recommend that all children with hypoglycemia of unknown etiology have a critical blood sample drawn at the time of hypoglycemia (blood glucose <50 mg/dL) or be admitted for a diagnostic evaluation.