Anesthetic management for child with idiopathic ketotic hypoglycemia: A case report

Woo, Su Jin; Kim, Soo Hwan; Chung, Mi Hwa; Choi, Young Ryong

Case Report

Pediatric Anesthesia

Anesthesia and Pain Medicine 2010;5(2):162-165.
Published online April 30, 2010.

Anesthetic management for child with idiopathic ketotic hypoglycemia: A case report

Su Jin Woo, Soo Hwan Kim, Mi Hwa Chung, Young Ryong Choi

Department of Anesthesia and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. anekim@hallym.or.kr

Abstract

Idiopathic ketotic hypoglycemia (IKH) is the common cause of clinically significant non-diabetic hypoglycemia among children. The cause of IKH is decrease in endogenous glucose production after a prolonged fasting. We report the experience of perioperative management for a six-year-old female child undergoing strabismus surgery with a history of IKH. This patient experienced two episodes of severe hypoglycemia and loss of consciousness caused by prolonged fasting at the age of 31 and 41 months. For elective general anesthesia, children should be restricted from fluid and foods to prevent pulmonary aspiration. Because of higher metabolic rate and larger body surface area-to-weight ratio than adult, pediatric patient are more prone to hypovolemia and hypoglycemia during preoperative fasting period. When the preoperative fasting is inevitable in the child with IKH, anesthesiologist should start the parenteral infusion with dextrose-containing fluid and periodically check blood glucose level during perioperative period.

Key Words: Glucose replacement, Ketotic hypoglycemia, Preoperative fasting