Hipoglicemia hiperinsulinémica neonatal transitoria: A propósito de un caso

objective: to report the case of a female newborn with transient hyperinsulinemic hypoglicemia which is a condition with several causes and an incidence of 1 in 40000 born alive babies. a review of the medical literature is done. clinical case: a female newborn from a complete pregnancy, with small size for her gestational age, presented at the age of two days with generalized tonic clonic movements, weak sucking and hypotonia that did not respond to medical treatment. her mother was not diabetic. physical exam: weight 2100 g, height 48cm. there was a slight jaundiced color in the skin. she was hypoactive with an acute cry. laboratory: glycemia: 7 mg/dl. capillary blood glucose: 13 mg/dl. serum insulin levels: 30.8 mu/ml, cortisol: 5.68ug/dl, human growth hormone: 25.8 ng/ml. thyroid function tests, complete blood count and arterial blood gases were normal. serum bilirrubin high. she received intravenous glucose at a rate of 8 mg/kg/min and dexamethasone 0.6 mg in i.v. bolus. twelve hours after her admission with a treatment with hydrocortisone, 5 mg/kg/day, her blood glucose was 13 mg/dl, her serum insulin 16.8 mu/ml, triglycerides 160 mg/dl, total cholesterol 87 mg/dl, c-hdl 39 mg/dl. she remained in the hospital for two weeks receiving an intravenous infusion of glucose (9 mg/kg/min) and hydrocortisone. the baby had a satisfactory evolution with a gradual lowering of her glucose needs as well as of glucocorticoids. she was discharged with a blood glucose level of 50 mg/dl and her insulin level was 3 mu/ml. conclusion: transient hypoglycemia is a frequent finding in babies at an age of 5-7 days. the diagnosis of hyperinsulinemic hypoglycemia should be thought when insulin levels are inappropriately elevated in states of hypoglycemia, the glucose requirements are higher than 6-8 mg/kg /min and the ammonia is slightly high. to prevent neurologic sequelae, the priority is to treat the hypoglycemia adequately. the majority of the transient cases are of spontaneous res