Hypoglycemia

Hypoglycemia in Children Attending the Critical Care Medicine in Developing Countries

“…When cells (primarily liver and muscle) are saturated with glycogen, additional glucose is stored as fat (Reid et al, 2003). When blood glucose levels fall, glucagon secretion functions to increase blood glucose levels by stimulating the liver to undergo glycogenolysis and release glucose back into the blood (Sperling et al, 2008, Halamek et al, 1997b. In starvation, the liver maintains the glucose level via gluconeogenesis (Sperling et al, 2008).…”

“…The major contribution of the brain to the basal metabolic rate is an important factor contributing to the frequency and severity of a hypoglycemic syndrome in the pediatric age Mullis, 2005, Mohnike et al, 1993). Cerebral glucose uptake occurs through a glucose transporter molecule and these molecules are carrier mediated and facilitate diffusion process that is dependent on blood glucose concentration but cerebral and cerebrospinal fluid (CSF) glucose uptake are not regulated by insulin (Sperling et al, 2008). Paucity of glucose transporter molecule can result in seizures due to reduced cerebral and CSF glucose concentrations although there might have normal blood glucose levels (Sperling et al, 2008.…”

“…Glucose levels increase transiently after meals to 6.6-7.7 mmol/L. Feedback systems return the glucose concentration rapidly back to the preprandial level, usually within 2 hours after the last absorption of carbohydrates (Fleisher, 2000, Halamek and Stevenson, 1998, Reid et al, 2003, Sperling et al, 2008. Insulin and glucagon are the important hormones in the immediate feedback control system of glucose (Sperling et al, 2008).…”

“…Cerebral glucose uptake occurs through a glucose transporter molecule and these molecules are carrier mediated and facilitate diffusion process that is dependent on blood glucose concentration but cerebral and cerebrospinal fluid (CSF) glucose uptake are not regulated by insulin (Sperling et al, 2008). Paucity of glucose transporter molecule can result in seizures due to reduced cerebral and CSF glucose concentrations although there might have normal blood glucose levels (Sperling et al, 2008. Thus, hypoglycemia should be considered as a medical emergency and treated very aggressively especially in children with other associated illnesses such as SAM, severe sepsis, septic shock, febrile neonates, prematurity and low birth weight in the critical care medicine ward.…”

“…Glucose is a source of energy storage in the form of glycogen, fat, and protein and hypoglycemia is the most common metabolic problem among pediatric patients in the critical care medicine (DePuy et al, 2009, Tita et al, 2009, Adamson et al, 1995, Alkalay et al, 2006. The lower limit of the accepted normal value of blood glucose level in newborn infants with associated illness especially in presence of hypoxemia and ischemia that already impairs the cerebral metabolism has not been determined (Sperling et al, 2008, Alkalay et al, 2006. Moreover, there are controversies regarding the definition of hypoglycemia .…”