Increased risk of hypoglycemia in children and young adults after undergoing bowel preparation for colonoscopy.

Abstract

Children have a higher risk of developing fasting hypoglycemia compared to adults, and colonoscopy bowel preparation may further increase this risk. The aim of this study is to evaluate the prevalence of and risk factors for hypoglycemia in children and young adults after undergoing colonoscopy bowel preparation. We performed a retrospective analysis of pre-procedure point-of-care glucose measurements in children and young adults who underwent outpatient colonoscopy at the Children's Hospital of Philadelphia between 1/1/2020-12/31/2024. We used Bayesian generalized linear mixed models to evaluate the relationship between demographic and clinical variables and hypoglycemia at three severity thresholds. 5129 colonoscopies of patients ages 5 months to 27 years old were included. Overall, 8% of patients were hypoglycemic (n = 391), 3% were moderately hypoglycemic (n = 128), and 1% were severely hypoglycemic (n = 41) before undergoing colonoscopy. On univariable and multivariable analysis, younger patients and patients with lower weight percentiles were significantly more likely to be hypoglycemic at all severity thresholds. Children <3 years old had the highest risk of hypoglycemia. Procedure location, having a feeding tube, and feeding problems were significantly associated with hypoglycemia on univariable analysis, but nonsignificant on multivariable analysis. Afternoon procedures were significantly associated with hypoglycemia on multivariable analysis. Children and young adults undergoing colonoscopy bowel preparation have a significant risk of hypoglycemia, especially those who are younger and with lower weight percentiles. Routine pre-procedure screening for hypoglycemia and implementation of preventative interventions during bowel preparation may be beneficial in the pediatric population.