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Review
. 2021 Aug 2:12:684011.
doi: 10.3389/fendo.2021.684011. eCollection 2021.

An Overview of Hypoglycemia in Children Including a Comprehensive Practical Diagnostic Flowchart for Clinical Use

Alberto Casertano  1 , Alessandro Rossi  2   3 , Simona Fecarotta  2 , Francesco Maria Rosanio  1 , Cristina Moracas  4 , Francesca Di Candia  1 , Giancarlo Parenti  2   5 , Adriana Franzese  1 , Enza Mozzillo  1
Affiliations
Review

An Overview of Hypoglycemia in Children Including a Comprehensive Practical Diagnostic Flowchart for Clinical Use

Alberto Casertano et al. Front Endocrinol (Lausanne). .

Abstract

Hypoglycemia is the result of defects/impairment in glucose homeostasis. The main etiological causes are metabolic and/or endocrine and/or other congenital disorders. Despite hypoglycemia is one of the most common emergencies in neonatal age and childhood, no consensus on the definition and diagnostic work-up exists yet. Aims of this review are to present the current age-related definitions of hypoglycemia in neonatal-pediatric age, to offer a concise and practical overview of its main causes and management and to discuss the current diagnostic-therapeutic approaches. Since a systematic and prompt approach to diagnosis and therapy is essential to prevent hypoglycemic brain injury and long-term neurological complications in children, a comprehensive diagnostic flowchart is also proposed.

Keywords: childhood hypoglycemia; congenital hyperinsulinism; endocrine hypoglycemia; glucose homeostasis; inborn errors of metabolism; neonatal hypoglycemia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the major metabolic pathways involved in glucose homeostasis during absorptive phase and fasting including exogenous carbohydrates (brown), glycogenolysis (red), gluconeogenesis (blue), fatty acid oxidation (green), ketogenesis and ketolysis (yellow). These mechanisms are tightly controlled by hormonal regulation. Defects in specific enzymes or transporters involved in those pathways as well as endocrine disorders may result in fasting intolerance and hypoglycemia. FFA, free fatty acids, KB, ketone bodies.
Figure 2
Figure 2
Hypoglycemia diagnostic flowchart.
See this image and copyright information in PMC

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