A 3-year-old child is brought by parents who found him unresponsive. There is a strong odor of alcohol on his breath, and his blood glucose is 30 mg/dL. The child had reportedly consumed the parent's flavored alcoholic drink. What is the mechanism of alcohol-induced hypoglycemia in children, and why are young children disproportionately affected?

• A Alcohol increases insulin secretion from pancreatic beta cells
• B Alcohol inhibits hepatic gluconeogenesis by generating NADH from ethanol oxidation; children are more susceptible due to lower glycogen stores and higher glucose utilization per kg ✓
• C Alcohol causes insulin receptor upregulation in muscle
• D Alcohol depletes B vitamins needed for pyruvate carboxylase in gluconeogenesis

Explanation

Ethanol is oxidized by alcohol dehydrogenase to acetaldehyde, generating NADH. The excess NADH shifts the NAD+/NADH ratio, inhibiting gluconeogenesis (NADH-dependent conversion of lactate to pyruvate is reversed, and key gluconeogenic enzymes are inhibited). Children are more vulnerable than adults because: (1) they have smaller hepatic glycogen stores relative to body weight, (2) higher glucose utilization per kilogram for brain metabolism, and (3) the liver switches to glucose from glycogen faster. After small amounts of alcohol, when glycogen is exhausted and gluconeogenesis is blocked, profound hypoglycemia results. Treatment is IV glucose (dextrose).

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.