Spontaneous hypoglycemia is not a disease but an indication of a defect in the metabolism of glucose in the organism. Excellent reviews by Skillern,1 Conn,2 and McQuarrie3,4 have indicated the large number of possible etiologic factors. Several authors have emphasized that hypoglycemia occurring in infants and children is not an uncommon condition. In McQuarrie's 3 report, 26 of 43 cases of hypoglycemia of infancy were classified as idiopathic and the author referred to these as "idiopathic infantile hypoglycemosis."In 1956, Cochrane et al.5 observed that certain hypoglycemic infants treated with a high-protein diet had an increased frequency of hypoglycemic attacks. This clinical observation that protein aggravates some cases of infantile hypoglycemia was supported by the finding of a marked fall in blood sugar in three cases after the administration of the amino acid L-leucine.5 The selection of this particular amino acid was partly fortuitous circumstance and partly the observation from reports in the literature that glucose administration to normal men results in a fall in blood amino acid, leucine being depressed more than other amino acids.6,7 Leucine was administered to observe if a reciprocal rela¬ tionship existed, i.e., feeding leucine would lower blood glucose. Two of the cases were siblings whose father gave a history of convulsions as an infant. There was no apparent cause for their hypoglycemia. The third infant was found to have an elevated plasma level of insulin-like activity and histological evidence of /?-cell hyperplasia of the pancreas after laparotomy. The oral administration of the amino acid L-leucine and of isovaleric acid produced a profound lowering of the blood glucose in all three in¬ fants and the father of the two siblings. No similar fall in blood sugar occurred when normal infants and adults were tested with L-leucine. Further studies of the role of amino acids in the hypoglycemia of infants have now been carried out. The experimental work and results, divided into three parts, are here presented. Part I describes observations made in 12 hypoglycémie infants and children after the oral administration of various amino acids. Part II describes the results of in vivo investigations in normal rabbits, rats, and dogs after the intravenous administration of L-leucine. Part III outlines the results of in vitro experiments of the effect of various amino acids on glucose uptake by isolated rat dia¬ phragm. A review of the literature relative to the topic is given, with a discussion of possible explanations for the hypoglycémie effect of L-leucine.A description of the treatment prescribed in the hypoglycémie infants is given to illus¬ trate the practical application of the investi¬ gative findings.Part I: Hypoglycémie Infants Six patients ranging in age from \% to 8"/> years and previously diagnosed as idiopathic hypo-