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January 13, 2008

Diagnosis and Symptoms, Hypoglycemia

Question from Untied States:

My 13-year-old daughter woke me up yesterday morning with flu-like symptoms, a fever of 102 degrees, crying due to pain in her shoulders, arms, legs, and head, dizziness, and nausea. I took her to the local nurse practitioner (NP) here in town. She did a quick strep test and a flu test; both were negative. She drew blood to test for mononucleosis and two more streps. I will get the other strep results in the morning. Although the first mononucleosis test was negative, the NP seems to think my daughter has mononucleosis. I will find out the results of them on Monday, but I was told to continue to administer the amoxicillin, and alternate Tylenol and Advil every two hours for the fever and pain, and for her to get plenty of rest and liquids. When I called for the results this morning, the NP asked me if she had eaten breakfast yesterday morning before she was seen in the office. I told her yes, two smoked sausage biscuits and half a bottle of Gatorade. Then, while we were waiting to be seen, she drank another whole bottle of Gatorade in the lobby. She said that my daughter's blood sugar was 48 mg/dl [2.7 mmol/L], and if she had eaten that much, it should be around 100 mg/dl [5.6 mmol/L] or so. Could this just be part of the mononucleosis (if that's what she has) or should I take her somewhere else now? Should I wait until she is feeling better? Today, my daughter is feeling better. Her temperature is 99. Her legs and arms still hurt, but she is not crying. Her appetite is good and she had lots of Gatorade. I have been giving her the antibiotic and Tylenol/ibuprofen every two hours. She was up for about one and a half hours all together yesterday, but today has already been up for about three hours. She was tired after a snack, played on her laptop for a few minutes, lunch, and a game of cards with mom. What is the normal sugar level of a very active 13-year-old female weighing 105 pounds? Should I be more concerned with the sugar level at this point or the illness? Could this illness be what's causing the sugar level to be so low?

Answer:

It could be the illness. The blood sugar of 48 mg/dl [2.7 mmol/L] could be seen in young women. I would look at the symptoms of hypoglycemia, in particular Hypoglycemia in People Who Do Not Have Diabetes. If you are seeing them often, then you might want to learn to check glucose at home and make sure the blood glucose is okay. Also, it depends on how long the blood sat before it was tested. Glucose can drop pretty quickly in the test tube. That can give false results pretty easily.

Do follow up, especially if there are symptoms as she gets well.

LD