Hypoglycemia + Fluids

Question 1

Risk Factors for Hypoglycemia

Answer 1

Premature
GDM
IUGR/SGA 
LGA
FAS

Question 2

Day 0 fluid requirement

Answer 2

0 = 60-80ml/kg/day

Question 3

Day 1 of life fluid requirement

Answer 3

1 = 80-100ml/kg/day

Question 4

day 2 of life TFI

Answer 4

2 = 100-120ml/kg/day

Question 5

day 3 of life TFI

Answer 5

120-140ml/kg/day

Question 6

day 4 and over TFI

Answer 6

150ml/kg/day

Question 7

Reasons for neonatal insensible water lose (IWL)

Answer 7

• Lower gestation - high BSA, and immature water permeable skin
• skin defects
• high body/ambient temp
• radiant warmer
• heat emitting phototherapy
• increased motor activity or crying

Question 8

Decreasing insensible water lose in neonates

Answer 8

• double walled incubator or plastic heat shield
• increased ambient humidity
• plastic bag
• humidification of inspirated gas in CPAP or ventilator
• antenatal corticosteroids promote maturation of skin and kidneys

Question 9

Assessing fluid/lyte status think:

Answer 9

History, assessment and lab work

Question 10

urine output goal for neonates

Answer 10

1-3ml/kg/hr

Question 11

Bolus does for neonates and rate of infusion

Answer 11

10ml/kg bolus immediately for shock, for dehydration 10ml/kg over 1 hour

Question 12

Birthweight <1000g day 1 TFI and day 7 TFI

Answer 12

80-100 day 1

160 day 7

Question 13

birthweight 1000-1500g TFI day 1 and day 7

Answer 13

day 1 = 80ml/kg/d

day 7 =150ml/kg/d

Question 14

birth weight >1,500g day 1 and 7 TFI

Answer 14

day 1 = 60ml/kg/d

day 7 = 150mk/kg/d

Question 15

Fluid choice first day of life

Answer 15

D10W without bytes

Question 16

Neonatal hypoglycaemia defined as

Answer 16

<2.6 during the first 48 hours of life

Question 17

Treatment for symptomatic hypoglycaemia in neonates

Answer 17

1. D10W at 2ml/kg followed by 4ml/kg/hr infusion. target BGL >2.6mmol/L

Question 18

Treatment of BGL in neonates >1.8 but <2.6

Answer 18

feed at 8ml/kg q2 hours

Question 19

Three medications that might be used in NICU for neonatal hypoglycaemia

Answer 19

1. glucagon
2. diaxozide
3. octerotide

Question 20

Treatment for BGL <1.8 with or without symptoms

Answer 20

IV dextrose 2ml/kg bolus followed by infusion 4ml/kg/hr

Question 21

When should neonates achieve a new set point for glucose

Answer 21

72-96 hours of life

3-4 days

Question 22

RF for neonatal hypoglycaemia

Answer 22

1. excessive insulin production (LGA, IDM)
2. Low glycogen reserve (IUGR, SGA)
3. Increased demand (critically ill)
4. Maternal conditions (DM, preeclampsia, maternal BB use)
5. newborn errors of metabolism, hepatic dysfunction

Question 23

Glucose checks and timing in HIE

Answer 23

• measure glucose every 20-30 minutes after birth
• measure glucose every 30-60 minutes after correction

neonatal hypoglycaemia was detected in 16% of newborns with HIE

Question 24

when does the 421 rule start

Answer 24

28days - 17 years

Question 25

rule of 50 for D50

Answer 25

give 1cc/kg

50x1=50

Question 26

rule of 50 for D25

Answer 26

Give 2cc/kg (25x2=50)

Question 27

Rule of 50 for D10W

Answer 27

5cc/kg

10x5=50

Question 28

rule of 50 for D5

Answer 28

Give 10cc/kg

5 x 10=50

Question 29

glucose triangle

Answer 29

top = want (ie, 15)
left = have (d10)
right = need (d50)

calculate the differences then add those two volumes to the same syringe. kids are annoying

Question 30

cross multiple to change dextrose concentration.

Example: d10 at TFI 140ml/kg/day to d15

Answer 30

1. TFI with D10=140ml/kg/d
2. multiple (d)10x140 = 1400
3. divide 1400/15 = 93.3
4. TFI with D15 = 93.3ml/kg/d