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Flashcards in Glucose Metabolism Deck (70)
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31

What infants are at increased risk for hypoglycemia secondary to abnormal endocrine function?

LGA, infants born to IDM, erythroblastosis fetalis

32

Fetal glucose levels are what percentage of maternal values?

70-80%

33

How does hyperinsulinemia occur in the infant of a IDM MOB?

the fetal pancreas will secrete insulin in response to glucose load and secretes levels appropriate to that environment. After delivery, with maternal glucose supply gone, the baby's pancreas may not be able to back off for hours or days, creating a hypoglycemic environment

34

What is erythroblastosis fetalis?

dz of hemolysis, the enzyme glutathione reductase is a by product of that hemolysis and it inactivates circulating insulin. As is inactivates insulin, it stimulates the pancreas to produce even more

35

What infants are at increased risk for hypoglycemia secondary to increased glucose utilization?

babes that are stressed or sick, with increased energy needs and may rapidly deplete their glycogen stores; perinatal asphyxia, hypothermia, neonatal sepsis and polycythemia/ hyperviscosity

36

What are some iatrogenic causes of hypoglycemia?

use of maternal drugs, erroneous placement of umbilical lines and administration of IV glucose to the mother during labor

37

What maternal drugs are known to contribute to neonatal hypoglycemia?

tocolytics, terbutaline, ratidine, propanolo and oral hyperglycemic agents; cause MOB to become hyperglycemia and the baby will over secrete insulin

38

What are the landmarks for umbilical line placement?

high lines: T6-T9; low lines: L3-4

39

How does erroneous line placement contribute to hypoglycemia in the neonate?

if UAC is T11-12, this is about the location that the celiac artery is connected to the aorta. If the UAC is there then is infusing dextrose, it may be close enough to this artery that it directly stimulates the pancreas to secrete even more insulin

40

How should hypoglycemia secondary to umbilical line placement be treated?

pull line into low lying position and within hours, hypoglycemia should be resolved

41

Why are so many symptoms of hypoglycemia neurological?

since the brain needs glucose to fx, many manifestations of hypoglycemia are neurological in origin

42

What are symptoms of hypoglycemia?

jitteriness/tremors, cyanosis, overt sz, apnea/irregular breathing, irritability/lethargy, hypothermia, weak and/or high pitched cry, poor feeding, eye rolling, sweating, cardiac failure, hypotonia, respiratory distress and pallor

43

What pathologic states include hypoglycemia in its presentation?

sepsis, asphyxia, hypocalcemia, CNS lesions, CHD, polycythemia/hyperviscosity and metabolic abnormalities

44

If a baby can be fed enterally, how should hypoglycemia be treated?

feed them, reassess glucose 15-30 min after the intervention

45

If a baby cannot be fed enterally, how should hypoglycemia be treated?

D10 bolus 2-4cc/kg given over 1mL/min (minimum infusion rate) followed by continuous IVF

46

What is the GIR of D10W at TF 80cc/kg/d?

5.5mg/kg/min

47

What course of action should be taken if hypoglycemia persists after intervention?

increase GIR either by increasing the rate of infusion or the concentration of glucose in the IVF; monitor line position, insert central lines if D>12.5%, monitor insulin levels

48

Why might insulin levels need to be drawn in an infant born to IDM MOB?

to document levels of hyperinsulinemia

49

What is the effect of insulin on an infant's respiratory function?

insulin tends to decrease surfactant production and quality and increase their cumulative risk for RDS (even if later GA)

50

What is insulin?

a hormone that enables glucose to enter the cell by ∆ cell wall permeability ; the major blood glucose reducing hormone

51

How does insulin levels affect brain utilization of glucose?

cerebral glucose utilization is NOT dependent on insulin

52

When does insulin first appear in the fetus?

by 12wk GA

53

How does hyper insulin affect growth?

insulin should work in synergy with growth hormone and is vital for growth. when the fetus has excessive insulin, then glucose, protein and fat synthesis is accelerated, leading to macrosomia

54

What is the maximal glucose oxidative capacity and when is it exceeded?

do not want to exceed 16-18mg/kg/min; occurs when excess glucose is converted to fat leading to increased O2 consumption and increased CO2 production

55

When should adjunct therapies be considered for the treatment of refractory hypoglycemia?

not until GIR is > 12mg/kg/min with no ∆ in glucose levels

56

What is glucagon and how is it helpful in treating refractory hypoglycemia?

an agent that releases glycogen from hepatic stores. its helpful when the newborn has adequate stores and hyper insulin levels. It allow for a RAPID, TRANSIENT increase in glucose concentration- may be helpful in babe that IV access is difficult

57

How is GIR calculated?

(%D x IVF rate)/ (6x wt in kg)

58

At what levels is an infant considered hyperglycemic?

term infant >125mg/dL; preterm infant > 150mg/dL

59

What are causes of hyperglycemia in the neonate?

inability to metabolize glucose, excess administration, medications, hyperosmolar formula, neonatal diabetes, sepsis, stress response (ex: asphyxia)

60

In what population is hyperglycemia of greatest concern?

infants <1500g