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May 30, 2005

Hypoglycemia

Question from Saudi Arabia:

My three year old son recently had a seizure around waking at 11 a.m. The left side of his body was partially paralyzed. Unable to determine what was going on, the doctors tested his blood sugar. It was only 27 mg/dl [1.5 mmol/L]. Saline was injected and a CSF test was carried out, but nothing was found. For three days, my son was on glucose and his blood sugars were normal. He has not had any more seizures. He did vomit and ate less the day of the seizure. Can you explain why his blood sugar dropped so low? Why didn't his body react and self-correct to bring his blood sugar to normal?

Answer:

There are not enough details for any diagnosis from what you have provided. You did not mention that your child had diabetes, so I assume that this is a severe case of hypoglycemia with convulsions in a child without diabetes. If this is a child with diabetes, then the possibilities are very different to consider.

The diagnosis of hypoglycemia is confirmed with a blood sugar of 27 mg/dl [1.5 mmol/L]. One needs to have a simultaneous insulin, growth hormone and cortisol level at the time of hypoglycemia to know if there is excess insulin or not. If so, then one must look for a problem producing too much insulin. If the insulin is low, then measuring the growth hormone and cortisol levels are even more important since this would let you know if there is growth hormone deficiency or cortisol deficiency. If both growth hormone and cortisol levels are low and insulin levels are also low, this would suggest a hypopituitary problem. If all three are normal during documented hypoglycemia (low insulin, high growth hormone, high cortisol), then the endocrine system is working properly and one must look for another cause of hypoglycemic convulsions. You should consult with a pediatric endocrinologist so that you know whether or not these tests were done and whether or not more detailed testing is required.

SB