From the Department of Internal Medicine, University of Oklahoma School of Community Medicine, Tulsa, OK.
Departments of Endocrinology and Diabetes.
Pediatr Emerg Care. 2020 Jul;36(7):322-326. doi: 10.1097/PEC.0000000000001634.
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.
本研究旨在确定在医院急诊部（ED）就诊的儿童（<18 岁）中先前未诊断的低血糖的发生率和病因。
对 2 年内所有急诊就诊进行回顾性分析，以确定年龄小于 18 岁且无先前已知病因的低血糖（<50mg/dL）患者。低血糖的评估是在自发性低血糖发作期间或通过禁食研究诱导低血糖期间进行的。当血糖<50mg/dL 时，同时测量胰岛素和抗胰岛素激素。
在研究期间，在 ED 就诊的 224125 名儿童中，有 160 名（1:1400）被记录为患有非先前已知疾病引起的低血糖。160 例低血糖患者中有 85 例（53%）接受了诊断评估。85 例中的 17 例（20%）被归类为患有引起低血糖的高危疾病，而 63 例（74%）患有低危疾病。75 例（47%）患者在 ED 就诊或住院期间未进行诊断评估。
在研究期间就诊的 ED 患儿中，有 1:1400（0.07%）的患儿出现不明原因的低血糖。假设在未进行诊断评估的患儿中均无高危疾病，那么 10.6%的低血糖患儿存在高危疾病。由于引起低血糖的高危疾病的发生率增加，以及与低血糖相关的长期健康风险，我们建议所有不明原因低血糖的患儿在低血糖发作时（血糖<50mg/dL）抽取关键血样，或入院进行诊断评估。
