An 8-month-old boy presents to the ED after having a seizure. His mother found him in his crib with both arms and legs shaking symmetrically. He appeared pale and had a glazed look on his face. The episode lasted 10 minutes. En route to the hospital, his blood glucose measured 39 mg/dL (2.2 mmol/L), and he was given intravenous dextrose solution.

According to his mother, he had a similar episode 1 month earlier when his blood glucose concentration was found to be 40 mg/dL (2.2 mmol/L). Laboratory evaluation, including CBC and basic metabolic panel, at that time yielded otherwise normal results, and he was discharged with no clear explanation of his condition. His mother reports that he has had seizurelike episodes with increasing frequency over the past month.

The infant was born vaginally at term, and his birth was complicated by abruption during delivery that resulted in perinatal asphyxia and...

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