TABLE 89.4 CAUSES OF CHILDHOOD HYPOGLYCEMIA Decreased availability of glucose Decreased intake—fasting, malnutrition, illness Decreased absorption—acute diarrhea Inadequate glycogen reserves—defects in enzymes of glycogen synthetic pathways Ineffective glycogenolysis—defects in enzymes of glycogenolytic pathways Inability to mobilize glycogen—glucagon deficiency Ineffective gluconeogenesis—defects in enzymes of gluconeogenic pathway Increased use of glucose Hyperinsulinism—islet cell adenoma or hyperplasia, ingestion of oral hypoglycemic agents, insulin therapy Large tumors—Wilms tumor, neuroblastoma Diminished availability of alternative fuels Decreased or absent fat stores Inability to oxidize fats—enzymatic defects in fatty acid oxidation Unknown or complex mechanisms Sepsis/shock Reye syndrome Salicylate ingestion Ethanol ingestion Adrenal insufficiency Hypothyroidism Hypopituitarism Clinical Considerations Clinical Recognition The acutely ill child warrants a glucose determination if the level of consciousness is altered because hypoglycemia may accompany an illness that interferes with oral intake The symptoms and signs of hypoglycemia are nonspecific and are often overlooked, especially in the infant and young child Any child presenting with a seizure, other than a breakthrough seizure with known epilepsy, or an altered level of consciousness should have a plasma glucose determination Triage Children with known diabetes who appear ill need a rapid bedside glucose for possibility of hypoglycemia or hyperglycemia All children with acute alterations in consciousness,