Hypoglycaemia

Question 1

What are normal serum and whole blood glucose levels during the first week of life?

Answer 1

Serum glucose is usually 2.5- 7.5 mmol/ l

Whole blood glucose levels are approximately 0.5 mmol/l lower than serum levels (due to increased PCV)

Question 2

What is the definition of hypoglycaemia? What is severe hypoglycaemia?

Answer 2

Blood glucose below 2 mmol/l or serum glucose below 2.5 mmol/l. Severe hypoglycaemia: blood glucose less than 1.5 mmol/l

Question 3

What are common causes of hypoglycaemia (try to use a category approach)

Answer 3

1. Decreased glycogen stores:
   - preterm infant
   - UGA/ wasted infant
   - post term esp if wasted
   - late feeding or early feeds with water or 5%glucose

2 increased demand for glucose:

• respiratory distress
• hypothermia
• infection
• Polycythemia
• septicemia

3. Increased insulin
   - infant of a poorly controlled diabetic mother
   - severe Rh disease
4. Liver damage
   - hypoxia
   - infection

Question 4

What is a rare cause of hypoglycaemia?

Answer 4

Pancreatic cell hyperplasia

Question 5

What is the clinical presentation of symptomatic hypoglycaemia?

Answer 5

CNS effects: floppiness, poor sucking, lethargy, jitteriness, apnoea and cyanosis, convulsions.
Cardiac effects: heart failure and respiratory distress

Question 6

How often should the blood glucose levels of at risk infants be monitored?

Answer 6

Every 1-3 hours for the first 24-48 hours

Question 7

What is the medical management of u controllable hypoglycaemia due to severe hyperinsulinism?

Answer 7

Glucagon, diazoxide and somatostatin

Question 8

How to treat mild hypglyc (1.5-2.0mmol/l)?

Answer 8

Milk feed. Keep warm.
Repeat Blood gluc after 30min
If mild hypoglyc persists, repeat feed sweetened with sugar and measure blood gluc after 30min.
If reading still below normal treat for severe hypoglyc.

Question 9

How to manage severe hypoglyc (below 1.5)?

Answer 9

Start iv infusion onf neonatalyte(10% dextr) (90ml/kg/24hrs)
- measure blood gluc after 15min. If hypoglyc persists increase iv dextr to 15% (10ml of 50% dextr to 100ml neonatlyte) + increase intake 120ml/kg/24hrs
+ 3ml of 10% dextr can be given into bulb of infusion set.
- can give hydrocortisone iv or glucagon iv or im.

Severe unresponsive hypoglyc usually due to hyperinsulinism.