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Hypoglycemic coma in children: causes, symptoms, diagnosis, treatment

Alexey Kryvenko, medical expert
Last reviewed: 07.07.2025

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Hypoglycemic coma is a condition caused by a decrease in blood glucose levels below 2.8 mmol/l (in newborns below 2.2 mmol/l).

Causes of hypoglycemic coma

First of all, hypoglycemia occurs due to insulin overdose, physical exertion and dietary violations. Liver and kidney diseases, as well as alcohol contribute to its development. Hypoglycemia in newborns is observed in prematurity, intrauterine growth retardation, hypoxia, asphyxia, hypothermia, sepsis, congenital heart defects. This problem can occur in children with glucagon deficiency, with type I glycogenosis, galactosemia, fructose intolerance, with adrenal insufficiency. The following factors are also significant: diabetes mellitus in the mother, hemolytic disease, exchange blood transfusions, hyperplasia or adenoma of the islet cells of the pancreas, leucine intolerance, treatment of the mother with chlorpramide or benzothiadiazides. It is necessary to consider the possibility of insulinoma.

Symptoms of hypoglycemic coma

Children suddenly become indifferent to what is happening, lethargic, sleepy. There is a feeling of hunger, headache, dizziness, and rapidly passing changes in vision. Unmotivated reactions are possible: crying, euphoria, aggression, autism, negativism. In the absence of timely assistance, consciousness becomes clouded, trismus, myoclonus and/or generalized seizures occur.

Diagnosis criteria

"Sudden" loss of consciousness in a child with diabetes mellitus who feels well. There are no signs of dehydration. Breathing is even, pulse is of satisfactory volume, blood pressure is normal or tends to increase. Pupils are wide, their reaction to light is preserved. Tendon reflexes are active. Glycemic testing confirms the diagnosis.

Emergency medical measures

Once the diagnosis is established, it is necessary to immediately administer a 40% glucose solution intravenously by bolus (2 ml/kg, not exceeding a total dose of 5 ml/kg) until full recovery of consciousness. If necessary, infusions are carried out in decreasing concentrations of glucose solution 20-10-5%, in addition, dexamethasone or methylprednisolone is administered. Glucagon - intramuscularly or subcutaneously 0.02 mg/kg.

It is permissible to administer epinephrine 10 mcg/kg. If the coma lasts for several hours, it is necessary to administer a 25% solution of magnesium sulfate at a dose of 0.1-0.2 ml/kg. In case of insulinoma, insulin secretion inhibitors are prescribed: diazoxide (hyperstat), octreotide (sandostatin), and in case of neoplasm diagnosis - streptozocin (zanosar).

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