Endocrine Abstracts

Introduction: Paediatric hypoglycaemia is a relatively common medical emergency. In order to allow identification of the underlying cause, investigations need to be performed urgently prior to treatment being given. If done correctly this can save the need for future investigations. A ‘hyposcreen’ costs ~£450 so careful consideration is needed to ensure correct patient selection, as inadequate investigations have further cost and patient safety implications.

Methods: Forty nine cases of proven or suspected hypoglycaemia (Glucose ≤2.6 mmol/l) were identified via the laboratory. Clinical notes, laboratory investigations, and results were reviewed.

Results: Forty two patients met the biochemical criteria for hypoglycaemia. Following review of individual clinical details it was agreed that only 48% of patients (20 patients; 15 neonates, five children) required investigation with a ‘hyposcreen’. Of these 20 patients, three did not have any ‘hyposcreen’ investigations performed. In the remaining 22 patients the cause of hypoglycaemia was identifiable, but despite this six were investigated inappropriately. In total 23 patients were investigated but only two had a full ‘hyposcreen’ completed. A total of 5/23 (22%) patients investigated were admitted for a planned fast due to incomplete ‘hyposcreens’. three patients did not become hypoglycaemic on fasting but despite this all five patients were investigated. None of these ‘hyposcreens’ were complete. Intermediary metabolites (96%), lactate (100%), cortisol (100%), insulin (87%) and growth hormone (87%) were taken most commonly with urine samples (48%) and ammonia (30%) taken least often. 35% cortisol, 20% insulin and 41% intermediary metabolite results were abnormal affecting ten patients, but only 4 had further investigations or follow up.

Investigations led to the diagnoses of pituitary aplasia (1), ketotic hypoglycaemia (3) and transient hyperinsulinism (1).

Conclusion: Investigations for hypoglycaemia are generally incomplete (91%) or inappropriate (27%). This has major cost implications for both the NHS and the individual who is investigated inadequately or incorrectly. We need to consider more stringent recommendations and dissemination of these to avoid inappropriate investigations and delay in diagnosis.