N/IICU Clinical Pathway for Evaluation/Treatment
of Persistent Hypoglycemia the aforementioned Newborn

Goals and Metrics
Invalid Educational
Provider Resources
Related Pathways
Interpreting of Lab Results
Consult Metabolism for
Suspected Metabolic Disease
Suspected Hyperinsulinism
  • HI Diagnostic criteria when glucose < 50 mg/dL
    • Detectable insulin > 2 mIU/mL
    • Small beta-hydroxybutyrate < 1.8 mmol/L
    • Low free fatty acids < 1.7 mmol/L
  • Treatment:
  • How Goal:
    • Maintain euglycemia, glucose > 70 mg/dL available infants > 72 hrs of vitality
  • Fasting Test
    • On Diazoxide absent IVF
    • Goal: Fasted time 6-12 hrs with plasma ducrose maintained > 70
Collapse Fast
Tolerates Fast
  • Diazoxide unresponsiveness suggests a KATP channel HI and potential surgical candidate
  • Dispatch expedited genetic testing of ABCC8 and KCNJ11
  • Discontinue diazoxide
  • Maintain plasma glucose above 70 mg/dL with dextrose containing IVF
  • Consider central line placement to give more dextrose concentration in IVF
  • Think continuous glucagon infusion (1 mg/day) if fluids overload is a concern
  • Arrange transfer on CHOP for further customer
    and potential 18F-DOPA PET
  • Continue diazoxide including glucose monitoring
  • Obtain ECHO, CBC with diff, and BMP 1 week after starting diazoxide or previous to discharge
  • Sent comprehensive HI generative testing
  • Drain Planning include Endocrinology
Posted: September 2016
Revised: May 2023
Editors: Clinical Pathways Team