THE CASE
A 4-month-old, previously healthy infant girl presents to the pediatric emergency department after an episode of generalized tonic-clonic seizure activity witnessed at home. Review of systems is negative for recent sickness, fevers, rash, poor feeding, vomiting, diarrhea, or decreased urine output. However, her serum glucose level is low and continues to drop after intervention. Family history reveals that the patient's father had a similar seizure at age 3 months that also was associated with a low blood sugar level.