Persistent Hypoglycemia, Newborn, N/IICU — Interpretation of Critical Fasting Labs — Clinical Pathway: ICU

Newborn Persistent Hypoglycemia Clinical Pathway — N/IICU

Interpretation of Critical Fasting Labs

Acidemia
Non-Acidemia
 
 
 
 
 
 
 
 
Elevated Lactate
Elevated
β-hydroxybutyrate
Free Fatty Acid High,
β-hydroxybutyrate Low
Free Fatty Acid Low,
β-hydroxybutyrate Low
 
 
 
 
 
 
 
 
  • Possible Diagnoses:
    • GSD 1
    • Fructose 1, 6
    • Bisphosphatase deficiency
    • PC deficiency
    • Hereditary fructose intolerance
  • Possible Diagnoses:
    • Growth hormone deficiency
    • Cortisol deficiency
    • Glycogen storage diseases
    • 0,3,6,9
    • Ketotic hypoglycemia
Possible Diagnoses:
FAO defects
  • In the normal fasting state:
    • Beta-hydroxybutyrate and FFA from fat breakdown are present with prolonged fasting and expect to be > 2.5 mmol/L
    • Insulin and C-peptide should be undetectable
  • IGFBP-1 is regulated by insulin and should be high when insulin is suppressed during hypoglycemia
  • Low cortisol and growth hormone are not diagnostic of hormone deficiencies. Hormone replacement should not be initiated without confirmation of these diagnoses through stimulation testing