Hypoglycemia in a Healthy Toddler
Bibliographic record
Abstract
Sulphonylurea ingestion is life-threatening in toddlers due to its strong and prolonged hypoglycemic effect, and is on the toddlers' "one pill can kill" list. Its administration to children may not be accidental. We discuss a case of non-accidental sulphonylurea ingestion by an 18-month-old girl, and the clinical reasoning process leading to identification of the causative agent for the patient's symptoms. A previously healthy 18 month-old girl presented to the Emergency Department with altered mental status and severe hypoglycaemia, which required intravenous hypertonic dextrose solutions to maintain euglycemia. A family history of type II diabetes prompted a search for sulphonylureas in the child's serum, which was positive. Further investigation led to the conclusion that the child's poisoning was the result of the mother's Munchausen-by-proxy syndrome. Sulphonylurea intoxication should be considered in previously healthy children presenting with hypoglycaemia. More than 20% of sulphonylurea poisonings reported in the literature correspond to Munchausen-by-proxy syndrome or homicide attempts. Initial management consists of rapid glucose infusion, but boluses should be avoided whenever possible to prevent rebound hyperinsulinism and worsening hypoglycemia. We stress the need to consider potential child abuse or neglect in a hypoglycaemic patient with sulphonylurea-using caregivers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".