| ID | 369 |
|---|---|
| Name | HYPOGLYCEMIA |
| Cause | Presenting feature: Jittery movements, coarse tremor & convulsions, may be apnoea, cyanosis or tachypnoea; hypothermia, limpness; tachycardia & excessive sweating is common. |
| Signs Symptoms | Sweating. Feeding difficulties, poor suck. Weak or high-pitched cry. Tremors. Hypothermia. Irritability. Lethargy/stupor. Hypotonia. |
| Diagnosis | The physiological serum glucose values in healthy newborns range between 3.3 and 5 mmol/L. Neonatal hypoglycemia should be defined as serum glucose less than 2.2 mmol/L in the first 72 h of life and less than 2.5 mmol/L thereafter |
| Investigations | The physiological serum glucose values in healthy newborns range between 3.3 and 5 mmol/L. Neonatal hypoglycemia should be defined as serum glucose less than 2.2 mmol/L in the first 72 h of life and less than 2.5 mmol/L thereafter Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns |
| Management | Management: 1 Hypoglycemia is common usually in babies at risks. At-risk babies are: i. birth asphyxia ii. IDM iii. L.B.W. iv. twins v. infant with Rh disease vi. hypothermic babies vii. infants of mothers with PET, prolonged 2nd stage or bleeding. 2. Monitor all babies at-risk 6 hourly with dextrostix for the first 24 hours & 8 hourly for the subseq-uent 24 hours or at shorter intervals if necessary. 3. If detrostix is between 0-25mg%, take blood sample for blood sugar level (BSL) & give l-2ml /kg of 25% dextrose stat without waiting for the result. Blood sample must be assayed as early as possible. If dextrostix is 25-45mg% in that case bolus i.v. dose need not to be given before the result comes. 4. If the BSL is within 45mg of the defined hypoglycemic levels, it is safer to start feeds straight away. 5. If hypoglycemia develops symptoms (as mentioned above)- give 2ml/kg of 25% or 5ml/kg of 10% dextrose i.v over 2-5 mins then maintain i.v infusion l00ml/kg/day (=7mg/kg/min) of 10% dextrose for next 24-48 hours. 6. If 7mg/kg/min of 10% dextrose fails to restore glucose homeostasis, increase progressively to 12mg/kg/min. & if that fails, consider use of i.v or i.m hydrocortisone 5mg/kg stat & then Img/ kg/6-hourly for 5-7 days. Glucagon 20mgm/kg can be tried even in small-for-date babies when there is a sudden severe fall of blood glucose that can not be raised with i.v dextrose. 7. Prevention: “At risk babies” who are clinically well, should have their stomaches washed out soon after birth & 5-10 ml of 5% dextrose left in the stomach at the end of the procedure. This is followed by a milk feed within two hours of birth; and maintains feed 1-2 hourly 60ml/kg 1st day, then 80ml, 100 ml, 120ml, 140ml & 150ml/kg on succeding days. 8. All cases of hypoglycemia require serum Ca, Mg, PO4 to be done as concomitant hypocalcemia is not uncommon. |
| Introduction | Hypoglycemia: A glucose level less than 40mg/dl (or 2.2mmol/l) at any time in any newborn, regardless of gestational age and/or whether symptomatic or not, is defined as hypoglycemia.”0 This refers to venous blood & plasma sugar showing as below- |
| History | |
| Etiology | see under cause |
| Clinical Features | see under sign and symptoms |
| Preventions | |
| Treatment | see under management |
| Complications | Severe, prolonged hypoglycemia in the neonatal period can have devastating outcomes, including long-term neurodevelopmental disabilities, cerebral palsy, and death |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team