Audit of acute hypoglycaemia in children: re-audit of procedures for diagnosis

Abstract

The new hypopack protocol has increased the number of appropriately performed investigations. Provision of information concerning dextrose infusion has assisted the interpretation of the hypopack results.

Paediatric hypoglycaemia; are we investigating appropriately and adequately?

“…A premade pack containing the required specimen tubes and biochemistry request forms, is one method to potentially improve the adequacy of investigation of hypoglycaemia 9. These ‘Hypoglycaemia packs’ contain all the relevant equipment and therefore aim to facilitate complete and timely investigations.…”

Update on investigating hypoglycaemia in childhood

“…67,68 Children tend to present with IKH between the ages of 18 months and seven years, 58 the commonest time when hypoglycaemic episodes are observed. 16,17 The exact pathogenesis of IKH is unknown; however, Bodamer et al 68 have shown using isotope studies that it may be due to a failure to maintain hepatic glucose production and not increased glucose oxidation. More recently Huidekoper et al 67 have supported this view and hypothesized that IKH may represent 'the lower tail of the Gaussian distribution of fasting intolerance in children'.…”

“…These initial investigations should provide information concerning intermediate metabolites and other diagnostic markers and allow the investigator to decide on further investigations and management options. 17 Numerous hospitals also have preprepared packs containing the appropriate specimen tubes for the investigation of hypoglycaemia in the wards and accident and emergency departments, termed 'hypopacks'. 16 If used properly, these packs can assist with the investigation and management of a child with suspected hypoglycaemia.…”

“…The success of any such pack depends on a partnership between the laboratory and the clinicians using them. 17 An ongoing education programme for staff using the packs is also important, especially with the regular rotation of junior doctors and agency staff.…”

“…However, personal practice has shown that may not be the case. 16,17 It is also important to note the exclusion of glucocorticoid use in suspected patients. Others have taken a more robust view and removed growth hormone from the protocols entirely.…”