September 28, 2003
Diagnosis and Symptoms
Question from Angola, New York, USA:
A few days ago, my nine year old son who weighs only 50 pounds, and who already has ADHD, Pervasive Developmental Disorders, Not Otherwise Specified (PPDNOS), a mild tic disorder, and a possible seizure disorder had a possible hypoglycemic episode at school. He was walking into the school after gym. This was after lunch, during which he had a slice of pizza, tater tots and chocolate milk. He said he had a severe pain in his abdomen which shot to his lower back which caused him to shoot both arms out to the side and arch backward. After this, he collapsed to the ground. The teacher called to him, so a friend helped him up, but he couldn’t walk, and he collapsed again. He told the nurse the symptoms that he had both earlier in the day and after the incident (blurred vision, numb fingers, swollen feeling in the tongue, and inability to use his legs).
He presented with a high heart rate and low shallow respiration as well as weak grip. He had slurred and garbled speech (kind of like he had marbles in his mouth). He had a CAT scan, blood work, a toxicology screen and urine culture all of which showed nothing. His pediatrician said she thought it was a hypoglycemic episode because of his size. What is your opinion?
Answer:
This sounds more like a type of seizure to me. It could be hypoglycemia- but would not be typical for it. However, the symptoms of low blood glucose can range across a big spectrum. The best way to confirm that “a spell” is due to low blood sugar is to test the blood glucose at the time of the spell. Of course, you could not do that then.
If, after you see a pediatric neurologist, there is still thought that this was due to low glucose, your pediatrician can instruct you in how to test blood glucoses at home with a special, easy to use meter. If low blood sugar is confirmed or still suspected, a visit to the pediatric endocrinologist may be helpful. However, would start with the presumption that this was a seizure and have the evaluation orchestrated by the neurologist.
DS
