Approach to hypoglycemia (pediatrics) Quiz: Ace Your Exams

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A 6-hour-old newborn delivered at 39 weeks' gestation is evaluated for jitteriness. The mother had little prenatal care. Rupture of membranes was at delivery, and maternal labs were within normal limits. No fever, vomiting, or seizures are reported. Temperature is 37° C (98.6° F), pulse is 165/min, respiration is 38/min, blood pressure is 70/40 mmHg, and oxygen saturation is 97% on room air. Weight is 4100 grams, and length is 49 centimeters. On physical exam, the infant is jittery. The anterior fontanelle is open and flat. Macroglossia is noted; mucous membranes are moist. The newborn’s left lower limb appears larger than the right. Cardiopulmonary exam is unremarkable. Umbilical hernia is noted with no organomegaly. Laboratory results are shown below. Which of the following is the most probable cause of this patient’s hypoglycemia?

 Laboratory value Results
 Blood glucose 35 mg/dL
 Serum bicarbonate 21 meq/L
 Insulin High
 C-peptide High
 Free fatty acids Low
 Betahydroxybutyrate Low
 Urine reducing substances Negative

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