Hiperinsulinemia and ketotic hypoglycemia as the most common forms of hypoglycemic states in childhood

Abstract

Hypoglycemia is defined asplasma glucose level sufficiently low to result in neurological damage. In the new-born age, the incidence of hypoglycemia ranges from 0.4-11.4%. Etiologically, low levels of plasma glucose can result from the hormonal or metabolic disorders; high doses of insulin, drug poisoning, liver disease or systemic disorders. The most common cause of severe and permanent hypoglycemia in the neonatal age group is congenital hyperinsulinism - the result of pancreatic cells hyperplasia and/or adenoma. Between two and five years of age, the most common form of hypoglycemic state is ketotic hypoglycemia of childhood, caused by limited amount of substrate. Diagnostic criteria include biochemical confirmation of low of glucose and/or high insulin levels, blood hormone testing (epinephrine, cortisol, growth hormone, glucagon levels), as well as metabolic screeningfor gluconeogenesis, glycogenolysis, and lipolysis disorders and disarrangements of fatty acid oxidation. Therapy is directed towards the substrate supplementation and the application of medications and fuels aiming atrapid attainment of normoglycemia (fruit juices, parenterally applied glucose and dextrose, glucagone, corticosteroid therapy); diazoxide and somatostatin therapy is indicated for patients with hyperinsulinemia.

Keywords

• hypoglycemia
• hiperinsulinemia
• ketotic hypoglycemia
• convulsions