Audit of acute hypoglycaemia in children: re-audit of procedures for diagnosis

Ann Clin Biochem 2008;45:486-488
© 2008 Association for Clinical Biochemistry



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Original Articles

Timothy F Lang1,
David Cardy1,
Dennis Carson2,
Clodagh M Loughrey3 and
Elinor Hanna4

1 Department of Clinical Biochemistry, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA;
2 Department of Child Health, The Queen’s University of Belfast, Belfast BT12 6BJ;
3 Department of Clinical Biochemistry, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, Northern Ireland;
4 Clinical Biochemistry, Princess of Wales Hospital, Coity Road, Bridgend CF31 1RQ, Wales, UK

Corresponding author: Dr Tim F Lang. Email: tim.lang{at}

Background: A protocol exists for the collection of samples to investigateunexplained hypoglycaemia, termed the ‘hypopack’.These packs are kept in Accident and Emergency departments andneonatal special care baby units throughout Northern Irelandand most wards of the Regional Children’s Hospital. A retrospectiveaudit of 107 hypopacks received between July 2001 and December2003 highlighted a number of problems: samples collected whenthe patient was receiving dextrose, incomplete clinical historyprovided, insufficient and haemolysed samples received and poorfiling of reports in charts. These were addressed by re-designingthe request form, updating the protocol and introducing a summativereport. The new protocol was introduced in April 2006.

Methods: The aim of this study is to assess whether the revised protocolimproved utility of the hypopack. A retrospective re-audit of100 hypopacks received between April 2006 and May 2007 was performed.

Results: Forty-nine percent of patients were hypoglycaemic (<2.6 mmol/L)compared with 35% in the original audit. In both audits, 33%of laboratory reports were missing from patients’ charts. Onecase of medium-chain acyl-CoA dehydrogenase deficiency, threecases of hyperinsulinism and two endocrine-related cases wereidentified.

Conclusions: The new hypopack protocol has increased the number of appropriatelyperformed investigations. Provision of information concerningdextrose infusion has assisted the interpretation of the hypopackresults.

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