{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T17:23:31Z","timestamp":1761153811969},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1103","license":[{"start":{"date-parts":[[2017,4,6]],"date-time":"2017-04-06T00:00:00Z","timestamp":1491436800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Paediatric hypoglycaemia is a relatively common medical emergency. To allow identification of the underlying cause, investigations need to be performed urgently prior to treatment being given. Careful consideration is needed to ensure correct patient selection, as inadequate investigations have further cost and patient safety implications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>49 cases of proven or suspected hypoglycaemia (glucose \u22642.6\u2005mmol\/L) were identified via the laboratory. Clinical notes, laboratory investigations and results were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Only 41% of patients (15 neonates, 5 children) required investigation with a \u2018Hyposcreen\u2019. Of these 20 patients, 3 had no investigations performed. In the remaining patients the cause for hypoglycaemia was identifiable, but 6 had investigations regardless. In total 23 patients had \u2018Hyposcreen\u2019 but only 2 were complete. Intermediary metabolites (96%), lactate (100%), cortisol (100%), insulin (83%) and growth hormone (87%) were taken most commonly with urine samples (52%) and ammonia (30%) taken least often. 40% cortisol, 29% insulin and 56% intermediary metabolite results were abnormal affecting 10 patients, but only 5 had follow-up. A total of \u00a36977 was spent on investigations, of which \u00a31630 has subsequently been found to be unnecessary. If investigations in the 23 children had been complete, this would have totalled \u00a32700 of unnecessary expenditure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Investigations for hypoglycaemia are generally incomplete (91%) or inappropriate (21%). This has major cost implications for both the National Health Service and the individual who is investigated inadequately or incorrectly. We need national evidence-based guidance for investigation thresholds and normal ranges to help avoid inappropriate investigations and delay in diagnosis.<\/jats:p><\/jats:sec>","DOI":"10.1136\/postgradmedj-2016-134308","type":"journal-article","created":{"date-parts":[[2017,4,8]],"date-time":"2017-04-08T00:10:23Z","timestamp":1491610223000},"page":"519-522","update-policy":"http:\/\/dx.doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Paediatric hypoglycaemia; are we investigating appropriately and adequately?"],"prefix":"10.1093","volume":"93","author":[{"given":"Louise","family":"Ramsden","sequence":"first","affiliation":[{"name":"Sheffield Children\u2019s Hospital NHS Foundation Trust , Sheffield, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Wright","sequence":"additional","affiliation":[{"name":"Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust , Doncaster, South Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuja","family":"Natarajan","sequence":"additional","affiliation":[{"name":"Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust , Doncaster, South Yorkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,4,6]]},"reference":[{"key":"2023041308303538000_","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jpeds.2015.03.057","article-title":"Recommendations from the pediatric endocrine society for evaluation and management of persistent hypoglycemia in neonates, infants, and children","volume":"167","author":"Thornton","year":"2015","journal-title":"J Pediatr"},{"key":"2023041308303538000_","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1053\/siny.2001.0044","article-title":"Hypoglycemic brain injury","volume":"6","author":"Vannucci","year":"2001","journal-title":"Semin Neonatol"},{"key":"2023041308303538000_","volume-title":"National Metabolic Biochemistry Network Guidelines for the investigation of hypoglycaemia in infants and children","author":"Bonham","year":"2012"},{"key":"2023041308303538000_","first-page":"655\u201369","volume-title":"Nelson textbook of pediatrics","author":"Kliegman","year":"2007","edition":"18th edn"},{"key":"2023041308303538000_","volume-title":"Service Level Agreement 2014\u201315","author":"The Pathology Directorate"},{"key":"2023041308303538000_","volume-title":"North Trent Neonatal Network Clinical Guideline Hypoglycaemia. 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