What is the remedy for puzzling seizure and low blood sugar?
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My daughter is 17mths old. Ongoing undiagnosed puzzling seizure & low blood sugar "episodes". She has had difficulty with bright light at night since birth & now can not tolerate light indoors. I am in the UK. Drs in the NHS have given up and I don't know what field of private specialist to turn to first.
Posted Wed, 5 Mar 2014 in Vision and Eye Disorders
Answered by Dr. Deepak Kishore Kaltari 3 hours later
Brief Answer: To consider Persistent Hyperinsulinemic Hypoglycae Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Dear XXXX I do understand your concern and apprehension. Being a Pediatric Surgeon i would consider the following possibility 1. Glycogen Storage disorder 2. Persistent Hyperinsulinemic Hypoglycaemia of children: It occurs due to over secretion of Insulin by pancreas. I had personal experience with couple of cases, in which the diagnosis was not suspected by Pediatrician and on clinical suspicion it turned out to be due to Hyperinsulinemic. Near Total Pancreatectomy is the treatment. As I do not have all the reports and detailed history available about your daughter , I would suggest you to get back to me with the same so that I can advise you further . In the meantime if the above possibility have not been considered, I would suggest you to discuss this with your Physician. Wishing your daughter a great health. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric Surgeon
Follow-up: What is the remedy for puzzling seizure and low blood sugar? 22 hours later
Dear Dr XXXXXXX Firstly thank you for giving me such a quick and detailed response to my question. I wish I had found you before! I have made an appointment with my GP for tomorrow in the hope that she will give me some of the results from tests not previously revealed. My daughter has had many tests including metabolic blood tests. Is it the blood tests that you would need? The other tests that she had were MRI, EEG and Barium meal all at 9 months after repeated seizure episodes both at home and as an inpatient. These 3 tests were clear at 9 months but were not performed by pediatric experts. I also noted she had something called an ix test done (maybe more than one). All pediatric appointments were stopped indefinitely after this and her records held from me. It has been so frustrating and heart breaking when I see her in agony yet am confused at what to do. Could you please tell me what blood test results to ask for tomorrow at first to get started? Also, would taking her to an optician help at all? I ordered a Philips Livingcolors light that changes the room light temperature and the red or orange setting seems to be soothing her. She has never tolerated television. Now it is much worse. Suddenly it seems to be worsening on a daily basis. Again sir, I can not thank you enough.
Answered by Dr. Deepak Kishore Kaltari 3 hours later
Brief Answer: Requires measurement of Serum Insulin level Detailed Answer: Hi Greetings Diagnosis of Hyperinsulinemic Hypoglycaemia requires high index of suspicion. It also requires consideration of other possibility of hypoglycaemia including glycogen storage disorder. It would be very helpful if you could provide the notes of physical examination by the Physician and the investigation done till date. Diagnosis of Hyperinsulinemic Hypoglycaemia is done by following Diagnosis Diagnosis of hyperinsulinism is based on the following criteria: (1) inappropriately raised plasma insulin levels in relation to blood glucose levels measured at various times postprandially and during periods of fasting (e.g., insulin level greater than 10 IlU/mL associated with a simultaneous glucose level less than 50 mg/dL), (2) a glucose infusion rate greater than 10 mg/kg/min required to maintain a blood glucose concentration above 35 mg/dL in the absence of glucosuria, (3) low plasma concentrations of free fatty acids and blood ketone bodies during hypoglycemia because insulin inhibits lipolysis and hence the production of ketone bodies. I would suggest you to discuss this possibility with your Pediatrician. Do get back to me anytime you need any further assistance. Take care Best Regards Dr Deepak Kishore
Follow-up: What is the remedy for puzzling seizure and low blood sugar? 3 days later
Hello Dr XXXXXXX I really can not thank you enough for your wise and thorough responses. I have begged my doctor for my daughter's records and / or a referral to a pediatric hospital but every GP has refused. I have many witness accounts and videos of cluster absence seizures, jerking at night and very pale "spacey" events. There have been many times when she has been unable to be woken and been floppy. I have taken to giving her dream feeds at night which has helped. Had her food allergies tested privately and restricted her diet thus and have her on Nutramigen AA formula still. I, myself, have epilepsy and have an assistance dog who is seizure alert trained. He does alert me to various episodes of my daughter but I am confused just what they are of course and what to do. At least he wakes me up. Yesterday her eyes hurt so badly she could not bear to go out into the sunshine. It broke my heart. She loves to see and play with other children in the park. One of the times that she was in hospital I remember they did her blood sugars a lot and they said that it was 4.0 when she was fasting and 4.0 when she had eaten each time which seemed strange. Because she was admitted with 1.7 and then it was raised to 8. something after just a fruit pot yoghurt. The only time they did her urine was at 2 weeks old which is when I presume they did ketones. They did a scan of her kidneys and they were a little on the small side at the time but "nothing to be concerned about" they said. Now I am told that they were not small. They did not scan again. I must say that this is not typical of a British hospital. There are some very good ones here. However, I do believe I am facing some racial diversity unfortunately and I am not very good dealing with confusion. I prefer to know facts, good or bad. Even a guess is better than the dark. So I appreciate your caring time. Thank you so very much. Sincerely and with great respect.
Answered by Dr. Deepak Kishore Kaltari 7 hours later
Brief Answer: Take care Detailed Answer: Hi Greetings I wish your daughter a happy and healthy life ahead. Do get back to me if you need any further assistance. The sugar level mentioned were low at time of admission bit have normalise later. Take care Best Regards Deepak
Follow-up: What is the remedy for puzzling seizure and low blood sugar? 1 hour later
If I were to consult a private doctor could you please advise me of what specialty to first direct me to? I am confused whether to consult a neurologist or a diabetic paediatrician at this time. Thank you for your kind and prompt answers.
Answered by Dr. Deepak Kishore Kaltari 8 minutes later
Brief Answer: Pediatric Neurologist and Endocrinologist Detailed Answer: Hi I work suggest you to take a combined opinion of Pediatric Neurologist and Pediatric Endocrinologist. It will really be helpful. Take care Best Regards Dr Deepak
Follow-up: What is the remedy for puzzling seizure and low blood sugar? 3 minutes later
Thank you so much Dr. XXXXXXX I can honestly say you have been incredibly helpful and I thank you from the bottom of my heart. Bless you MB
Answered by Dr. Deepak Kishore Kaltari 5 minutes later
Brief Answer: Take care Detailed Answer: Wishing you and your family a happy and healthy life. I would be happy if I could be of any help to you any time Take care Regards Deepak