March 1, 2004
Hypoglycemia
Question from Shelby, Ohio, United States:
My daughter, at 16 months of age, had a seizure in her pediatrician’s office. She did not eat or drink well that day, as she was sick with a virus, although I do remember she ate one or two crackers and drank some juice right before we left for her appointment. In addition to the seizure, she went into cardiac and respiratory arrest. She was stabilized, sent to our local Children’s Hospital for 24 hour observation, and sent home with the diagnosis of febrile seizure. Her fever at the time of the seizure was 102.7 and her blood glucose level immediately following the seizure was below 30 mg/dl [1.6 mmol/L], but I do not know the exact number. I suspect her seizure was caused by the hypoglycemia, although the pediatrician insists that it wasn’t. Nonetheless, the hypoglycemia was present at that time, regardless of the cause of the seizure.
My daughter is now almost three years old and has speech delay, low muscle tone, and hyperreflexia in both of her legs. Occasionally, she does display signs of hypoglycemia. Her symptoms are mild, but do exist. I randomly tested her earlier this week before breakfast, as she was sluggish and looked pale. Her blood sugar was 67 mg/dl [3.72 mmol/L], which I believe is on the low side of normal. She has been tested for certain metabolic disorders that can affect glycogen release. She is going back to the genetics clinic in April for another evaluation. Can hypoglycemic episodes cause neurological damage? If so, is it something that can be corrected?
Answer:
A single febrile seizure on its own is unlikely to have been the cause of any permanent neurological damage, but the episode at age 16 months was accompanied by both hypopglycemia and very probably by cerebral anoxia as a result of the cardiac and respiratory arrest, both of which can certainly cause permanent central nervous system damage. As your daughter grows, it is unlikely that damaged pathways will be repaired, although she may well learn to accomodate to any disability. What is important is to make sure that there is no underlying cause for repeated hypoglycemia and this is obviously what the genetics clinic have been doing in looking for glycogen storage diseases and, now, for inborn errors of fatty acid and organic acid metabolism. It sounds as though she is in good hands.
DOB
