Hypoglycemia and Hyperglycemia Flashcards
Glucose provides approximately what percentage of fetal energy needs
60% to 70%
In the AAP report, the authors recommend measuring blood glucose levels and treatment for the following:…?
- Symptomatic infants with blood glucose <40 mg/dL with intravenous (IV) glucose
- Asymptomatic infants at risk for hypoglycemia defined as late preterm (34 to 36 6/7 weeks of gestation), term SGA, IDM, or LGA
a. First 4 hours of life …
i. Initial screen <25 mg/dL (should be done within the first hours after birth), infants should be fed and rechecked, and if the next level, 1 hour later, is <25 mg/dL, treatment with IV glucose should be administered.
ii. If the second check is 25 to 40 mg/dL, feeding may be considered as an alternative to IV glucose.
b. Four to 24 hours of life…?
i. Glucose <35 mg/dL, infants should be fed and glucose rechecked in 1 hour.
ii. If glucose continues to be <35 mg/dL, IV glucose should be administered.
iii. If recheck after initial feeding is 35 to 45 mg/dL, feeding may be attempted.
iv. Recommendation is to target glucose >45 mg/dL.
Bedside reagent strips will be within——— mg/dL and less accurate in the hypoglycemic range.
±10 to 15
Congenital hyperinsulinism ….?
Hyperinsulinism is seen in mutations of genes encoding the pancreatic beta-cell adenosine triphosphate (ATP)–sensitive potassium channel, such as ABCC8 and KCNJ11 which encode for SUR1 and Kir6.2. Elevated insulin levels are also associated with loss-of-function mutations in HNF4A gene. A
hyperinsulinism Secondary to other conditions ..?
Syndromes such as Beckwith–Wiedemann syndrome (macrosomia, mild microcephaly, omphalocele, macroglossia, hypoglycemia, and visceromegaly)
Maternal drug intake leading to hyperinsulinism in newborn …?
Maternal tocolytic therapy with beta-sympathomimetic agents (terbutaline)
UAC and hypoglycaemia in newborn ..?
Malpositioned umbilical artery catheter used to infuse glucose in high concentration into the celiac and superior mesenteric arteries T11T12, stimulating insulin release from the pancreas
Defects in carbohydrate metabolism leads to hypoglycaemia in newborn ..?
i. Glycogen storage disease
ii. Fructose intolerance
iii. Galactosemia
Endocrine deficiency causing neonatal hypoglycaemia……?
i. Adrenal insufficiency
ii. Hypothalamic deficiency
iii. Congenital hypopituitarism
iv. Glucagon deficiency
v. Epinephrine deficiency
Defects in amino acid metabolism causing hypoglycaemia …?
i. Maple syrup urine disease
ii. Propionic acidemia
iii. Methylmalonic acidemia
iv. Tyrosinemia
v. Glutaric acidemia type II
vi. Ethylmalonic-adipic aciduria
Maternal or infant therapy with beta-blockers (e.g., labetalol or propranolol). Possible mechanisms include the following:…?
i. Prevention of sympathetic stimulation of glycogenolysis
ii. Prevention of recovery from insulin-induced decreases in free fatty acids and glycerol
iii. Inhibition of epinephrine-induced increases in free fatty acids and lactate after exercise
The glucose level can fall up to—- mg/dL/hour in a blood sample that awaits analysis
6 mg/dL/hour
If the insulin level is normal for the blood glucose level, when to consider additional testing to evaluate for other causes of persistent hypoglycemia…?
carbohydrate metabolism
endocrine deficiency and
defects in amino acid metabolism
What is Mini bolus in IV glucose therapy ..?
The traditional 200 mg/kg dextrose “mini-bolus” given before instituting a continuous dextrose infusion for the treatment of neonatal hypoglycemia may not be necessary in asymptomatic hypoglycemic newborns
Role of hydrocortisone in neonatal hypoglycaemia….?
hydrocortisone, 10 mg/kg/day intravenously in two to three divided doses
Hydrocortisone reduces peripheral glucose utilization, increases gluconeogenesis, and increases the effects of glucagon
Diazoxide usage in neonatal hypoglycaemia…?
Diazoxide (8 to 15 mg/kg/day in divided doses every 8 to 12 hours) may be given orally to infants who are persistently hyperinsulinemic.
This drug inhibits insulin release by acting as a specific ATP-sensitive potassium channel agonist in normal pancreatic beta-cells and decreases insulin release.
It can take up to 5 days for a positive effect to be seen.
Octreotide in neonatal hypoglycaemia…?
Octreotide (5 to 20 μg/kg/day subcutaneously or intravenously divided every 6 to 8 hours).
It is a long-acting somatostatin analog that inhibits insulin secretion.
It can be used when diazoxide does not successfully control the glucose level.
Tachyphylaxis can develop.
18F-fluorol-DOPA positron emission tomography (PET) in neonatal hypoglycaemia..?
Identify focal lesions in the pancreas and consider surgical treatment by subtotal pancreatectomy.
Long-term effects of neonatal hypoglycaemia …?
Infants and children had visuo-motor problems, poor executive function, low literacy, and numeracy.
Infants with hypoglycemia have been reported to exhibit a typical pattern of CNS injury particularly in the parieto-occipital cortex and subcortical white matter.
Definition of HYPERGLYCEMIA in newborn ..?
It is usually defined as a whole blood glucose level higher than 125 mg/dL or
plasma glucose values higher than 145 mg/d
Why hyperglycemia is bad in newborn ..?
major clinical problems associated with hyperglycemia are hyperosmolarity and osmotic diuresis.
Osmolarity of more than 300 mOsm/L usually leads to osmotic diuresis (each 18 mg/dL rise in blood glucose concentration increases serum osmolarity 1 mOsm/L)
Drugs causing hyperglycaemia in newborn ?.?
The most common association is with glucocorticoids.
Other drugs associated with hyperglycemia are steroids, caffeine, theophylline, phenytoin, and diazoxide.
Neonatal diabetes mellitus…..?
mutations involving regulation of the ATP-sensitive potassium channels of the pancreatic beta-cells. Activating mutations of either the KCNJ11 gene that encodes the Kir6.2 subunit or the ABCC8 gene that encodes the sulfonylurea receptor (SUR1) have been implicated in the cause of neonatal diabetes
Which glucose transport proteins immaturity leads to hyperglycemia in newborn…?
GLUT-4
When to use Exogenous insulin therapy in neonatal hyperglycemia…?
when glucose values exceed 250 mg/dL despite efforts to lower the amount of glucose delivered or when prolonged restriction of parenterally administered glucose would substantially decrease the required total caloric intake
The insulin available in India is…?
40 U/mL
Dilution with 40 mL of dextrose (or normal saline) makes the preparation as 0.1 U/ mL
usual starting dose of insulin is …?
Rate of infusion is 0.05 to 0.2 unit/kg/hour (usual starting dose is 0.05 unit/kg/hour)
