Hypoglycemia is a metabolic imbalance that requires prompt recognition and treatment to prevent associated irreversible central nervous system damage. Hypoglycemia can be caused by decreased glucose intake (fasting), increased utilization (hyperinsulinemic state), or diminished production (enzymatic defects). One or more of these mechanisms can be responsible for hypoglycemia secondary to drug adverse reactions or overdoses. In pediatrics, drugs commonly associated with hypoglycemia include hypoglycemic agents, salicylates, and β-adrenergic blocking agents. We present two pediatric cases to illustrate the association between hypoglycemia and propranolol treatment in behavioral disorders.

Case 1 is a 9-year-old white boy with a history of attention deficit disorder and anxiety disorder currently taking methylphenidate hydrochloride (10 mg po TID or 1.2 mg/kg/d), and propranolol (120 mg po every morning and 60 mg po every night or 7.2 mg/kg/d). Propranolol and methylphenidate hydrochloride were given on the day of admission. The patient was walking to a...

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