Investigating paediatric hypoglycaemia: Dynamic studies at a tertiary paediatric hospital
Lara E Graves1, Kelly Stewart1, Geoffrey R Ambler1,2
1Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Insights
Fasting studies are safe and effective for diagnosing childhood hypoglycaemia and guiding management. These tests help determine causes and safe fasting intervals for affected children.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Clinical Audit
Background:
- Childhood hypoglycaemia necessitates specific investigations for accurate diagnosis.
- Diagnostic samples during hypoglycaemic events are often unavailable, requiring alternative testing methods.
- Fasting studies and glucose challenges are crucial for identifying aetiologies and managing glucose dysregulation.
Purpose of the Study:
- To review the utility and diagnostic yield of fasting studies, prolonged oral glucose challenges, and starch loads in paediatric patients.
- To assess the effectiveness of these tests in diagnosing the cause of hypoglycaemia and guiding management.
- To evaluate the safety and outcomes of these diagnostic procedures.
Main Methods:
- A retrospective audit of clinical records was conducted.
- Data were collected from a Tertiary Paediatric Endocrine/Metabolic Testing Unit in Sydney, Australia (2013-2018).
- The audit reviewed the purpose, procedures, and outcomes of 170 tests in 138 children.
Main Results:
- 170 tests were performed, including 122 fasting studies, 20 oral glucose tolerance tests (OGTTs), and 48 starch load tests.
- Diagnostic studies were performed in 66% of cases, leading to a pathological diagnosis in 31% (most common: accelerated starvation).
- Management studies (34%) informed safe fasting durations, medication/diet adjustments, and pathology resolution.
Conclusions:
- Fasting studies are a safe and effective diagnostic tool for childhood hypoglycaemia.
- These studies aid in confirming or excluding pathological causes of hypoglycaemia.
- Fasting studies are valuable for guiding the management of diagnosed paediatric hypoglycaemia cases.
Aim:
Paediatric hypoglycaemia often requires specific investigations to determine aetiology. Samples from the time of hypoglycaemia may not be available and a diagnostic fasting test may be required. Additionally, fasting studies can determine safe fasting intervals and prolonged oral glucose challenges can assess hypoglycaemia due to abnormal post-prandial glucose handling. This audit reviewed the current utility and yield of fasting studies, prolonged oral glucose challenges and starch loads.
Methods:
Retrospective audit of clinical record to determine purpose and outcome of tests performed at a Tertiary Paediatric Endocrine/Metabolic Testing Unit in Sydney, Australia, from 2013 to 2018 inclusive.
Results:
One hundred and thirty-eight children (aged 3 weeks-17 years) underwent 170 tests: 122 fasting studies, 20 five-hour OGTTs, 22 uncooked corn starch loads and six modified waxy maize starch (Glycosade) loads. The majority were for diagnostic purposes (n = 113, 66%), with 57 (34%) to guide management in patients with known diagnoses. Following diagnostic studies, 35 (31%) patients received a pathological diagnosis, the most common of which (n = 19, 17%) was accelerated starvation. Hypoglycaemia developed in n = 15/113 (13%) during the diagnostic studies. Management studies helped determine length of safe fast, adjustment of medication or diet and document resolution of pathology.
Conclusion:
Fasting studies remain a safe and effective method to assist with diagnoses, confirm or exclude pathological causes of childhood hypoglycaemia and to guide management of known diagnoses in the paediatric population.
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