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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
The incidence of hypoglycemia is 1-5 per 1000 new borns.
Hypoglycemia is the most common metabolic disorder seen in newborns.
The incidence among LGA and LBW infants are 80/1000 and 150/1000 newborns respectively.
Definition
Hypoglycemia is defined as a plasma glucose level <45 mg/dl in symptomatic neonate or <35 mg/dl in an asymptomatic neonate.
In first few hours after birth, hypoglycemia defined as <30 – 35 mg/dl in preterm newborn and <35 -40 mg/dl in the term infant.
In exclusively breastfed full term AGA newborn blood glucose may fall after birth to approximately 1.8 mmol/L by 1hr of age with subsequent rise to levels over 2.0 mmol/L in first three days of life.
Symptoms
Jitterniness or tremors
Apathy
Episodes of cyanosis
Intermittent apneic spells
Tachypnea
Weak or high pitched cry
Lethargy & porr feeding
Convulsions
Neonatal brain can utilize ketones and lactate as substrate of energy, hence newborns tolerate low blood glucose levels without symptoms.
Investigations
Urine ketones : Presence of urine ketones suggest ketotic hypoglycemia, adrenal or growth hormone deficiency,& other inborn errors of metabolism.
Serum Insulin levels, C-Peptide, Glucagon
S. Cortisol
Treatment
Asymptomatic hypoglycemia : Increase the breastfeeding frequency, supplement with a breast milk substitute or intravenous glucose therapy. Blood glucose levels should be checked 30 minutes to one hour after feeding to ascertain that the levels have increased in infants.
Symptomatic
Lucas et al found that intellectual performenace was poor at 18 months in infants who had been born prematurely and who had experienced serum glucose levels persistently <47 mg/dl. Thus any child having blood glucose level <45mg/dl should be treated.
Intravenous glucose should be administrated.
Age | Bolus dose | Maintenance |
Neonate | D10 5ml/kg PO/IV/IO/NG | 6ml/kg/h D10 |
Infant | D10 5ml/kg or D25 2ml/kg | 6ml/kg/h IV D10 |
Child | D25 2ml/kg | D10 6ml/kg/h for 1st 10kg + 3ml/kg/h for 11 -20kg + 1.5 ml/kg/hr for each kg>20. |
Blood glucose should be checked 30 min after starting the infusion.
Glucose infusion rate (GIR) of 5 -8mg/kg/min is normally required to maintain blood glucose levels.
GIR > 12mg/kg/min hyperinsulinemia or inborn error of metabolism is suspected. GIR>20 mg/kg/mi is diagnostic of hyperinsulinemia.
GIR = Volume (ml/kg/d) * glucose concentration /144
If adrenal insufficiency is suspected Hydrocortisone 25mg IV in neonates and 50 mg for children's should be administrated.
Other drugs used : glucagon, hydrocortisone, thiazides, nifedipine and octerotide.
Updated on 21/1/2015
Reference
Tintinalli
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor