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From Abington, Pennsylvania, USA:

Last week, my 18 month old was extremely lethargic and cold (temp 95.5F) and we were unable to wake him so we took him to our local hospital. They first told us that his blood sugar had dropped which triggered the hypothermia and dehydration, and his ketones were very high.

The day before he seemed a little "off" but nothing we hadn't encountered before, a loose stool in the morning, mild temp in the afternoon (100.5F), a little picky with food, but he did have Cheerios, a cookie and 4 ounces of milk before bedtime (around 8:30 pm). It seemed like teething to me, and bedtime was normal. but when we woke him (at 8:30 am), he was unresponsive and cold.

He stayed in the hospital for three days, and while they were trying to figure out why the blood sugar dropped, they found that his alkaline phosphatase levels were very elevated and were not sure if it was related or not. They did rule out liver disease and rickets. While in the hospital, they ran many tests but were unable to come up with anything concrete. The hospital pediatric unit is staffed by physicians from a major children's hospital, and the attending physicians ran the case by the gastroenterologists, endocrinologists, and metabolic doctors from there, but still no answers.

They did mention that it may be a reaction to a random virus and will not happen again. However, they then proceeded to tell me I should follow up with specialists, but they couldn't agree on which ones to follow up with. I basically received a lot of conflicting information and am very worried and confused. One of the doctors said I should have his blood sugar tested at by a children's hospital endocrinologist and then another said it wasn't necessary to put him through that.

We are taking him to his pediatrician in two days to go over a course of action, but I am trying to gather all the information I can. Can hypoglycemia trigger hypothermia? Should we have him tested by a endocrinologist to rule out a recurrent problem? Could the elevated alkaline phosphatase level be related to the hypoglycemia? Could there be an issue with fatty acid oxidation? Is it possible he had a seizure during the night? Is it possible that this was a reaction to a virus? What would you suggest for follow up? Are there any other questions I should be asking? Any information or suggestions that you can provide will be greatly appreciated!


I understand your apprehension and concerns. The children's hospital near you is a wonderful, wonderful place for the care of children and their sub-specialty staff, especially in the realm of diabetes and glucose metabolism and endocrinology, are among the worlds best!

The short version as to how to answer your question(s) is "yes" -- low glucose can certainly be associated with low body temperature. The key to trying to figure out things is to try to determine why your son had a low glucose. I am certain that a number of studies were done that probably exclude several possibilities.

One of the dilemmas that occur with trying to figure out the cause of hypoglycemia is that some of the important diagnostic studies must be obtained during the time of hypoglycemia. Important key hormones to measure during the low glucose would include (among others) the insulin level, the growth hormone level, and the cortisol level. Given the low body temperature, I would be especially curious about the cortisol levels to assess adrenal gland function. Therefore, sometimes the patient is watched carefully under a controlled environment while the doctors induce a low glucose (either by fasting the child or by giving different medications or hormones) thus being ready to measure how the appropriate "glucose regulatory" mechanisms work. Tests for fatty acid oxidation problems can be tricky to figure out but often do not need to be obtained during hypoglycemia.

The elevation in the alkaline phosphatase is also curious. Offhand, I cannot think of a single condition to tie-in the low glucose and the high alkaline phosphatase, other than liver disease. As you alluded to, this enzyme is commonly made in the liver and in the bones so it is good that liver disease and rickets have been excluded. I presume that they look for a small, occult bone fracture. Alkaline phosphatase can also be made in the intestine. You did not indicated just how high the value was, but there certainly have been reports of temporarily very elevated levels in some infants following non-specific viral conditions. and there is an inherited form of elevated alkaline phosphatase so they might check the parents' levels, too.

Do you need to see an endocrinologist? Maybe. If this was due to "something bad", low blood glucose will recur. I think you have to judge for yourself about the need for follow up with the specialist and your own sense of comfort.


Original posting 15 Aug 2002
Posted to Daily Care


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Last Updated: Tuesday April 06, 2010 15:09:38
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