Abstract
Symptomatic hypoglycemia developed 5 to 45 months after transplantation in nine children who had renal transplants before 6 years of age. During hypoglycemia, serum glucose levels ranged from 14 to 39 mg/dl (0.8 to 2.1 mmol/L). Hypoglycemic episodes occurred between 1.7 and 7.5 years of age. Six patients had generalized seizures; the remaining three had diaphoresis with stupor or lethargy. None of the children had serious infections, diabetes, congenital defects of glucose metabolism, or a history of treatment with insulin or oral hypoglycemic agents. Six patients had hypoglycemic symptoms after a prolonged fast, and at least four had ketosis. Eight of the nine patients were receiving propranolol when hypoglycemia occurred. No differences in the daily prednisone dose, the number of transplant rejection episodes, or the frequency of treatment with medications other than propranolol were noted between hypoglycemic patients and 56 normoglycemic age-matched renal transplant recipients. All hypoglycemic patients were subsequently treated with frequent feedings and discontinuation of propranolol. No further hypoglycemic episodes have occurred in eight of nine patients. Symptomatic hypoglycemia should be recognized as a potentially devastating complication of pediatric renal transplantation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1002-1007 |
| Number of pages | 6 |
| Journal | The Journal of pediatrics |
| Volume | 113 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 1988 |
Bibliographical note
Funding Information:Symptomatic hypoglycemia in children beyond the neonatal period is uncommon. ~,2 Hypoglycemia has been described in adults with chronic renal failure 312 and has been variously attributed to chronic substrate insufficiency, altered levels of glucoregulatory hormones, and metabolic abnormalities induced by drugs or alcohol. Altered glucoregulatory hormone levels in children with chronic renal insufficiency have been described, ~3-~9 but we are unaware of reports of hypoglycemia without associated liver disease, serious infection, exogenous insulin adminis- Dr. Wells is the recipient of a National Research Service Award (DK 07764), National Institutes of Health. Additional grant support from the National Institutes of Health (AM 07087 and HD17386). Material in this article appeared in abstract form (Pediatr Res 1987;2114, pt 2\]:243A). Submitted for publication Nov. 16, 1987; accepted July 12, 1988. Reprint requests: Thomas G. Wells, MD, Arkansas Children's Hospital, Department of Pediatrics, 800 Marshall St., Little Rock, AR 72202.
