Diagnosis and management of hypoglycaemia beyond the neonatal period

Hypoglycaemia in childhood beyond the neonatal period is a relatively common problem and is defined as a plasma glucose level of less than 2.8 mmol/litre. If it is not recognized and treated promptly, it can lead to significant morbidity and mortality. Hypoglycaemia has many and varied causes, including endocrine disorders, inborn errors of metabolism, poisoning, severe infections and ketotic hypoglycaemia (which should be a diagnosis of exclusion). When possible, blood and urine samples to determine the cause of hypoglycaemia should be taken before treatment is instigated, as some abnormalities are unmasked only during the episode of low blood sugar. Once the cause has been identified, treatment may involve avoidance of prolonged fasting, dietary manipulation, medication or even surgery.