Infant Hypoglycemia Revealing Factitious Disorder Imposed on Another
https://doi.org/10.15605/jafes.041.S1
- Author:
Mastura Ibrahim
1
;
Munzir Jamil
1
;
Meenal Mavinkurve
2
Author Information
1. Department of Paediatrics, Hospital Tuanku Ja’afar Seremban
2. Department of Paediatrics, International Medical University, Seremban
- Publication Type:Journal Article
- MeSH:
Infant;
Hypoglycemia
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):140-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Hyperinsulinemic hypoglycemia of infancy may be
congenital or acquired, and rarely due to factitious hypoglycemia imposed by another. A thorough medical and
social history, critical sampling, and screening for inborn
errors of metabolism are crucial.
Case:A 5-month-old, ex-29 weeker, twin female infant, born to
a non-consanguineous couple was admitted at 4 months
with severe refractory hypoglycemia and seizures requiring
a glucose infusion rate (GIR) of 16 mg/kg/min. Critical
sampling suggested hypoglycemia due to exogenous
insulin: glucose 1.1 mmol/L, ketones 0.2 mmol/L, insulin
1,208 pmol/L (17.8–173), and C-peptide 18.2 pmol/L (366–
1,466). Free fatty acids were not raised; growth hormones
were 2.223 µg/L (0.14–6.27) and cortisol >1,000 nmol/L
(145.4–619.4). Metabolic and genetic testing excluded
glycogen storage disorder. Two months prior, she was
admitted with a severe human metapneumovirus and
parainfluenza infection, hypoglycemia, lactic acidosis
and left ventricular hypertrophy. Her twin had died of
sudden infant death syndrome. Examination revealed
a small puncture mark on the abdomen, but otherwise it
was unremarkable. The GIR dropped dramatically over
3 days and the intravenous dextrose was discontinued.
Normoglycemia was maintained on 3-hourly feeds and
she tolerated an age-appropriate fast before discharge. No
hypoglycemic episodes were reported. Of note, the mother
suffered from bipolar disorder and had access to insulin for
gestational diabetes mellitus. The infant is currently in foster
care, is scheduled to have neuroimaging and continues to
have growth and developmental follow-up.
Conclusion:Factitious hypoglycemia should be suspected when there
are red flags in the clinical history and critical sampling
demonstrates high insulin levels, suppressed C-peptide
in the face of hypoglycem ia with low ketones and low
free fatty acids. A multidisciplinary approach involving
paediatrics, psychiatry, and child protective services is
mandatory
- Full text:2026081013293623129EP_P010.pdf
