A&E shift

You are the doctor in an inner-city clinic in London on your second night shift ever. At around 5 o'clock in the morning a baby is brought in by ambulance, accompanied by his obviously worried and confused grandmother.

The paramedic explains the situation to you: there is a history of recurrent, projectile vomiting and an extremely low blood sugar level. Daniel, who is about 6 months old, is lying apathetically, whilst his grandmother, tears in her eyes, runs her hands through his hair - which is drenched with sweat.

The paramedic shows you the suspiciously low blood sugar level reading which was performed on a BM stix meter in the ambulance - they suggest pronounced hypoglycaemia.

What are the clinical signs of hypoglycaemia?

  • Cyanosis and pallor
  • Feeding difficulties
  • Hypertonia
  • Lethargy
  • Seizures
  • Shrill crying
  • Tremor, irritability

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