Table 2

Recommended guidelines to referring hospitals for transfer of babies with hyperinsulinism (transfer of babies/children with hypoglycaemia, regardless of aetiology)

(1) Before transfer discuss the case with the endocrine registrar/consultant on call
(2) Must have secure intravenous access at all times before transfer (even if not requiring intravenous fluids at time of transfer)
(3) Baby/child must be transferred with nurse and doctor escort
(4) Before transfer ensure you have:
 10% dextrose (preferably 500 ml bag)
 Hypostop/sugary drink
 Glucagon intramuscular/intravenous 0.1 mg/kg up to 1 mg maximum
 Blood glucose monitoring equipment
(5) Monitoring:
 Check blood glucose before leaving, then hourly if stable, or 15–30 minutes if unstable
 Aim to keep blood glucose above 3.0 mmol/litre
(6)  Hypoglycaemic event during journey (blood glucose < 2.6 mmol/litre)
 Recommendations: 2 ml/kg of 10% dextrose bolus over three minutes, start maintenance infusion 6–8 mg/kg/min, which approximately equals 5 ml/kg/hour of 10% dextrose
 Recheck blood glucose 15 minutes later. If still low increase infusion by 1 mg/kg/min until normoglycaemia attained
 If intravenous access lost give:
   (a) Hypostop and repeat blood glucose in children > 2 years
   (b) Give one dose of glucagon and repeat blood glucose measurement for infants