of 150 to 250 mg/dL Additional supplemental insulin may be required, depending on when the child last received insulin and the response to simple hydration Note, if hyperglycemia is a coincidental finding, the diagnosis requires thoughtful consideration How traumatic was the blood draw? How upset was the child? What medications or IV fluids were given to the child just before the phlebotomy? What was the child drinking while waiting to see the physician? Are the symptoms in any way related to the hyperglycemia? How sick is the child? The sicker the child is, the less likely it is that hyperglycemia is reflective of diabetes Three simple evaluations are helpful in determining whether the hyperglycemia is circumstantial or suggestive of diabetes Brief hyperglycemia resulting from a stress response to phlebotomy or secondary to oral intake rarely results in significant glucosuria; therefore, a urine dip for glucose is often helpful Second, in the absence of ongoing stress or input, glucose tends to fall over time A point-of-care glucose is rarely stressful Therefore, repeating a glucose measurement by fingerstick to hours after the original sample was sent is useful in separating disease from nondisease Third, hyperglycemia secondary to these factors is usually mild (150 to 250 mg/dL) More significant hyperglycemia should raise the suspicion of diabetes, glucose intolerance, or an underlying medical illness that is producing a significant counterregulatory response HYPOGLYCEMIA Goal of Treatment To recognize hypoglycemia, initiate a diagnostic laboratory evaluation, and begin corrective treatment immediately if exhibiting any symptoms CLINICAL PEARLS AND PITFALLS Hypoglycemia in absence of ketones is consistent with hyperinsulinism or fatty acid oxidation enzyme deficiencies Every acutely ill child with an altered level of consciousness should have a rapid bedside glucose determined Treat severe hypoglycemia with rapid IV administration of 0.25 g dextrose per kilogram body weight Current Evidence Hypoglycemia is generally defined as plasma glucose of less than 50 mg/dL, regardless of whether symptoms are present A differential diagnosis of hypoglycemia, as it may present in the ED, is provided in Table 89.4 Hypoglycemia may be secondary to insulin therapy for diabetes Excluding this category, almost all hypoglycemia in children occurs during periods of decreased or absent oral intake, often coupled with increased energy demand (e.g., viral gastroenteritis with fever) Postprandial hypoglycemia is unusual in children, except in those who have had prior gastrointestinal surgery A few select poisonings can produce hypoglycemia Because glucose is necessary for cellular energy production in most human tissues, the maintenance of an adequate blood glucose concentration is important for normal function The plasma glucose reflects a dynamic balance among glucose input from dietary