Practice Variations in Pediatric Hypoglycemia Management: A Survey of Emergency Medicine Physicians

Objective There are several treatment guidelines for the management of hypoglycemia in the pediatric population. The goal of this study was to better understand current practice patterns in the management of pediatric hypoglycemia in the emergency department setting.  Methods A survey consisting of clinical vignettes was used to gather information on the treatment threshold for both symptomatic and asymptomatic hypoglycemia. The survey also asked about the dose of intravenous dextrose used to correct this problem. This survey was distributed using pediatric and general emergency medicine listservs.  Results For asymptomatic patients with hypoglycemia, 29.9% (55/184) of respondents stated that they would not typically give a dextrose bolus before trialing oral intake to increase blood glucose levels, regardless of glucose value. For those who had a glucose threshold at which they would give an intravenous dextrose bolus, 29.3% (54/184) indicated that it was at a glucose level less than 50 mg/dL. If the asymptomatic patient had already failed an oral challenge, 39.7% (73/184) of respondents would intervene at a threshold below 60 mg/dL. For patients who had symptoms that could be attributed to hypoglycemia, 95.6% (175/183) would give an intravenous dextrose bolus immediately, as opposed to trialing oral intake first. The most common threshold below which physicians would intervene was 60 mg/dL (36.6%, 67/183). When treating hypoglycemia, 81.0% (149/184) of respondents chose options equivalent to 500 mg/kg of dextrose. Conclusions This study illustrates significant practice variation in the management of pediatric hypoglycemia in terms of the blood glucose threshold for intravenous dextrose treatment. The dextrose bolus size had less variation between physicians, with most surveyed following the classically taught 500 mg/kg of dextrose. Under or overtreatment has implications for patient-centered outcomes, including length of stay, and this variation may indicate the need for more studies to better define the risks and benefits of each treatment plan for standardization of care.