Pershad J, Monroe K, Atchison J
Department of Pediatrics, University of Alabama, Birmingham, USA.
Pediatr Emerg Care. 1998 Aug;14(4):268-71. doi: 10.1097/00006565-199808000-00006.
To 1) determine the prevalence of hypoglycemia in childhood in a pediatric emergency department (ED), 2) determine epidemiology of idiopathic ketotic hypoglycemia (IKH), 3) determine diagnostic yield of the workup of hypoglycemia, and 4) review a diagnostic approach to hypoglycemia.
Urban pediatric ED of a tertiary level children's hospital.
Retrospective review of all medical records with a primary or secondary diagnosis of hypoglycemia (ICD-9 code 251.2) seen at the ED between 1/92 and 8/95.
Thirty-one patients were identified. Mean blood glucose was 34.2 mg/dl. Prevalence of hypoglycemia among population seeking care in our ED was 6.54/100,000 visits. Eighteen patients were diagnosed with IKH for a prevalence of 3.9/100,000. IKH demographics were: mean age 27.7 months; 12 males, 6 females; 8 white, 9 black, and 1 not available. The weights of five patients were < 25th percentile. Fourteen of the 18 IKH patients had hormone studies done insulin [cost $40], growth hormone [$69], cortisol [$54]. All 14 had appropriately suppressed insulin levels (< 5microU/ml) and high cortisol levels > 22 microg/ml. Thirteen of the 14 had normal or high growth hormone (GH) levels (0.7-6 ng/ml). Four IKH patients had urine drug screens ($280); all were negative. Although no IKH patient was febrile, six had sepsis workups ($380); all were negative. Urine ketones were positive in 15 of the 18 tested (> 3+ in eight patients). Mean anion gap was 20 (range: 16-30). Eight of the 18 IKH patients were discharged from the ED after return to normal status.
IKH is the most common cause of hypoglycemia in children beyond the infancy period. In its typical presentation (previously healthy one- to five-year-old, with normal growth and development, who presents with a first episode of symptomatic fasting hypoglycemia and appropriate degree of ketonuria, without hepatomegaly, and with resolution of symptoms on administration of glucose), an extensive and overzealous workup for endocrinopathy or inborn error of metabolism is not necessary.
1）确定儿科急诊科（ED）儿童低血糖的患病率；2）确定特发性酮症性低血糖（IKH）的流行病学特征；3）确定低血糖检查的诊断率；4）回顾低血糖的诊断方法。
一家三级儿童医院的城市儿科急诊科。
回顾性分析1992年1月至1995年8月期间在该急诊科就诊的所有主要或次要诊断为低血糖（ICD-9编码251.2）的病历。
共识别出31例患者。平均血糖为34.2mg/dl。在我们急诊科就诊人群中低血糖的患病率为6.54/100,000次就诊。18例患者被诊断为IKH，患病率为3.9/100,000。IKH患者的人口统计学特征为：平均年龄27.7个月；男性12例，女性6例；白人8例，黑人9例，1例信息不详。5例患者体重低于第25百分位数。18例IKH患者中有14例进行了激素检查，包括胰岛素（费用40美元）、生长激素（69美元）、皮质醇（54美元）。所有14例患者胰岛素水平均得到适当抑制（<5微单位/毫升），皮质醇水平升高（>22微克/毫升）。14例患者中有13例生长激素（GH）水平正常或升高（0.7-6纳克/毫升）。4例IKH患者进行了尿液药物筛查（费用280美元）；结果均为阴性。虽然没有IKH患者发热，但6例患者进行了败血症检查（费用380美元）；结果均为阴性。18例接受检测的患者中有15例尿酮体呈阳性（8例患者>3+）。平均阴离子间隙为20（范围：16-30）。18例IKH患者中有8例在恢复正常状态后从急诊科出院。
IKH是婴儿期以后儿童低血糖最常见的原因。对于其典型表现（既往健康的1至5岁儿童，生长发育正常，首次出现有症状的空腹低血糖且尿酮体程度合适，无肝肿大，给予葡萄糖后症状缓解），无需对内分泌病或先天性代谢缺陷进行广泛且过度的检查。
