Hypoglycemia in the Emergency Department

Infants and children presenting to the emergency department with hypoglycemia are a diagnostic emergency and require urgent treatment. The metabolic adaptive patterns of fasting occur earlier in children compared to adults, most notably with the development of ketone bodies. Glucose is the preferred energy source for the brain; however, when deprived of glucose, ketone bodies are an alternative fuel that may cross the blood-brain barrier. As infants and children have a relatively larger brain to body size and their rates of glucose use are higher, they are at increased risk of hypoglycemia. Collection of the "critical sample" to assist in the diagnostic work-up and urgent treatment to stabilize blood glucose levels is of paramount importance to protect the developing brain from glucose deprivation.