Hypoglycemia Among Young Children Presenting With Metabolic Acidosis

Objectives Metabolic acidosis in children can present with varying degrees of severity, duration, and etiology. A minor illness can lead to hypoglycemia and ketosis in young children due to poor metabolic reserve. We aimed to study the etiology and type of metabolic acidosis, associated electrolyte abnormalities, and mortality rate in children presenting with metabolic acidosis. Methods We performed a retrospective review of young children aged 1-71 months from January 2014 to March 2015 presenting with metabolic acidosis. The demographic data and laboratory values were extracted. We compared the demographic and clinical characteristics of children presenting with metabolic acidosis with and without hypoglycemia. Results The most common diagnoses were acute gastroenteritis (AGE) and vomiting with dehydration. Hypoglycemia was present in 28% of patients, with an overall mortality rate of 2%. Children with acidosis and hypoglycemia tend to be older (42.0 (IQR:20.5-55.5) vs 18.5 (IQR: 7.0-46.3) months; p<0.01), more likely to have diagnoses of vomiting or AGE (67% vs 24%; p<0.01), and have a shorter hospitalization (3 vs 5 days; p<0.05) with no mortality (0% vs 2.6%; p=0.38) compared to children with metabolic acidosis and no hypoglycemia. Conclusions Hypoglycemia is common among children presenting with metabolic acidosis. Hypoglycemia should be considered in young children initially presenting with metabolic acidosis. This will help structure our initial management protocols for the pediatric population.