hypOglycemia Flashcards
hypoglycemia increase in
1- Prematurity.
2- Hypothermia.
3- Hypoxia.
4- IUGR.
5- Maternal diabetes.
6- Maternal glucose infusion in labor.
defintion of hypoglycemia
<35 mg/dl ….. 1-3 h
<40 mg/dl …… 3-24 h
<50 mg/dl …… > 24 h
risk factor for hypoglycemia
1- hyperinsulinemic state i.e. IDM
2- Intrauterine malnutrition i.e. IUGR
3- Increased metabolic need i.e. asphyxia
4- Genetic or primary metabolic defects i.e. galactosemia
5- others i.e. GH deficiency
clinical features of hypoglycemia
1st - 2nd day
asymptomatic – symptomatic (CNS, CVS, RS)
prevention
1- breast fed within 1 hour + gluc screen after 30 min ( if asymptomatic& no ci for feeding)
2- 10% gluc iv (if oral not possible )
3- all - serial blood glucose level during the 1st day of life.
Pathophysiology of IDM
1- maternal hypERglycemia ➡️ fetal hypERglycemia ➡️ fetal hypERinsulinemi
2- fetal hypER glycemia & insulinemia cause
➖acidosis 🔜 stillbirth
➖ increase hepatic glucose uptake and glycogen synthesis & accelerate lipogenesis and protein synthesis.
🔺↑ cytoplasm of liver cells
🔺Hypertrophy and hyperplasia of the pancreatic islets with ↑number of β cells.
🔺↑ weight of placenta and infant organs (except the brain).
🔺Extramedullary hematopoiesis
AT BIRTH : sudden ⬇️ gluc but insulin still ⬆️ , hypoglycemia
clinical feature (IDM)
دنفوش مدنفس
1- large & plump (due to ↑ body fat and large viscera) with puffy & plethoric facies.
🔴 may be of normal or LBW (if delivered before term or if associated with maternal vascular disease).
2- lie on their backs with leg abducted and flexed and with their hands alongside their heads (like premature posture), tremulous, and hyperexcitable during the first 3 days of life (but may be hypotonic, lethargic, and poor sucker).
tachypnia in 1st 2 days ddx
1- Hypoglycemia.
2- Hypothermia.
3- Polycythemia.
4- Heart failure.
5- Transient tachypnea.
6- Cerebral edema from birth trauma or asphyxia.
7- Respiratory distress syndrome.
maternal cx of DM
1- Ketoacidosis.
2- Hypoglycemia.
3- Pre-eclampsia.
4- Polyhydramnios.
5- Retinopathy.
6- Pyelonephritis.
7- Chronic hypertension.
neonatal cx of IDM
1- Prematurity.
2- Intrauterine fetal death.
3- Macrosomia.
4- Birth trauma & asphyxia.
5- RDS (antagonistic effect between cortisol and insulin on surfactant synthesis).
6- TTN.
7- Hypoglycemia & hypocalcemia.
8- Polycythemia.
9- Indirect hyperbilirubinemia.
10-Congenital anomalies
– Cardiac; Cardiomegaly (30%), heart failure (10%),
septal hypertrophy, VSD, ASD, TGA, COA. – Skeletal; Lumbosacral agenesis is most common.
– CNS; Neural tube defects.
– Renal; Hydronephrosis, renal agenesis & renal vein thrombosis (flank mass, hematuria and
thrombocytopenia).
– GIT; Duodenal or anorectal atresia & small left colon syndrome.
Rx Asymptomatic hypOglycemia
Oral feeding
1- Oral tolerance and 2- Asymptomatic transient hypoglycemia (plasma glucose is >30mg/dL) 3- Normoglycemic high risk infant
اذا واحد من الشروط انتقض ننطي iv gluc
IV glucose infusion at rate of 4- 6mg/kg/min.
1- Oral intolerance or 2- Asymptomatic transient hypoglycemia (plasma glucose is <30 mg/dL)
Rx of Symptomatic hypOglycemia
-w/ seizure
-w/out seizure
10% D bolus (الجرع تختلف) & maintenance (نفس الجرع)for both
🔴IV bolus glucose infusion
1- w/out seizure
🔺2 mL/kg (200mg/kg).
2- w/ seizure
🔺 4 mL/kg (400mg/kg).
🔴 maintenance glucose infusion
6–8 mg/kg/min
🟣If hypoglycemia recurs
- repeat the bolus and increase the infusion rate
- If ≥ 15 mg/kg/min is inadequate to eliminate symptoms give :
〰️hydrocortisone 2.5mg/kg/6hours
〰️or prednisolone 1mg/kg/day
🟣 If neonatal hyperinsulinism is present, and the infant is unresponsive to glucose and steroid give:
➰unresponsive to glucose and steroid give diazoxide 10-20 mg/kg/day orally 3 times/day
➰ or long acting somatostatin (Octreotid)
🟣 Infant with persistant hyperinsulinemic hypoglycemia (Nesidioblastoma & islet cell adenoma
➿subtotal pancreotectomy.
