Endocrine Abstracts

Introduction: Hypoglycaemia is a common paediatric medical emergency, hence prompt treatment with appropriate investigations of causes is essential.

Aims: (1) Review current practice of investigating hypoglycaemia in children; (2) Improve awareness of local guidelines; (3) Overcome practical hurdles when investigating hypoglycaemia

Methods: • Retrospective audit of investigation of hypoglycaemic patients over a year using clinical notes

• Education regarding local guidelines with pre/post teaching quiz

• Introduction of ‘Hypo-packs’ containing sample bottles and list of investigations

Audit results: Over a 12-month period (May 2017–18), 20 hypoglycemic patients were identified.

Demographics

11/20= Male; Average age=35 months (7 months - 6 years); Most common presentation: gastroenteritis (11/20).

8/20 had BM < 2.6 at/during admission; 7/8 had a hyposcreen. 1/8 had an abnormal result: cortisol 17 – with a final diagnosis of hypoadrenalism.

9/20 patients had ketones measures with the initial low BM.

7/20 with BM > 2.6 at/during admission (range: 2.8–3.1) also had hyposcreens.

0/14 patients who had a hypo-screen had complete investigations as per our local guidelines.

Final diagnoses

13/20 ketotic hypoglycaemia, 3/20 - gastroenteritis, 1/20 - epilepsy, 1/20 hypoadrenalism, 1/20 suprasellar mass, 1/20 unknown (transferred out)

Hyposcreens were missed on 2 patients requiring extended overnight fast and resulted in delayed discharge. 2 patients were readmitted for further investigations.

Quiz results

18 responders pre-teaching and 19 responders post-teaching: medical students, GP trainees, paediatric trainees and consultants. Results pre-teaching in brackets.

• (22%) 47% correctly defined hypoglycaemia as < 2.6

• (89%) 89% recognised ketones as the most important bedside test

• (39%) 84% could locate trust guidelines

• (22%) 28% could list correct investigations and (56%) 74% correct sample bottles for a hyposcreen

• 100% thought that pre-made “hypo-packs” would be useful

Conclusions: • Preliminary results show that we may be over-investigating hypoglycaemia and that our current practice is variable in terms of investigation and mangement.

• Educating the clinical team has improved awareness of local guidelines.

• This project is ongoing; we are also reviewing our guidelines to define criteria for 1st and 2nd line investigationswe.

• We plan to re-audit in 6 months’ time to evaluate the effectiveness of the introduction of hypo-packs and further education.