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The Prevalence of Hypoglycemia in Children With Vomiting or Decreased Oral Intake and Irritability

Heeley-Ray, Tim MD; Nemeth, Joe MD; Mitchell, John MD

doi: 10.1097/PEC.0b013e31824d8c8b
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Objective This study aimed to estimate the prevalence of hypoglycemia in children younger than 5 years presenting to the emergency department with vomiting or decreased oral intake and irritability.

Methods Children aged 1 month to 5 years presenting to the emergency department with vomiting (twice or more) or decreased oral intake (>50%) during the past 24 hours and irritability as part of the history of present illness were enrolled. Capillary blood glucose was obtained at triage. Patients with glucose level higher than 3.0 mmol/L were considered normoglycemic. Patients with glucose level of 3.0 mmol/L or lower were re-triaged (acuity level increased by 1), and sent to a treatment room with the recommendation that our institution’s hypoglycemia protocol be applied.

Results Of the 145 enrolled patients, 2 were hypoglycemic, for an estimated prevalence of 1.4%. The mean capillary blood glucose level was 5.4 mmol/L, and the range was 2.8 to 11.8 mmol/L. The average age of participants was 21 months, and 48.3% were female. Most were triaged category 4 or 5, and the most common discharge diagnoses were gastroenteritis, viral illness, and vomiting not yet diagnosed.

Conclusions Hypoglycemia is a rare occurrence in all-comers younger than 5 years with vomiting or decreased oral intake, even with early signs of neuroglycopenia. Measuring the capillary glucose is better left to the discretion of the physician than as part of triage.

From the Department of Emergency Medicine, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.

Disclosure: The authors declare no conflict of interest.

Reprints: Joe Nemeth, MD, Department of Emergency Medicine, Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Quebec, Canada H8P 3S9 (e-mail: joe.nemeth@mcgill.ca).

© 2012 Lippincott Williams & Wilkins, Inc.