NEONATAL METABOLIC PROBLEMS Flashcards
HYPOGLYCAEMIA
Definition: Blood glucose level less than _____mg/dl in any infant irrespective of gestational age.
45
Hypoglycemia
Aetiology:
1.Hyperinsulinism
•Infants of ___________ mother—Initial ___________ state leads to pancreatic islet ___________ leading to ___________.
•___________-___________ Syndrome: ___________, omphalocoele, ___________, intractable hypoglycaemia.
•Insulin producing tumours—___________
•___________ disease
diabetic ; hyperglycaemic
hypertrophy ; hyperinsulinism.
Beckwith-Weideman ; macrosomia,
macroglossia ; nesidioblastoma
Rhesus haemolytic disease
Hypoglycemia
Aetiology: 2)Decreased production / storage
____________
________
Starvation
__________ of metabolism
Prematurity
IUGR
Starvation
Inborn errors of metabolism
Hypoglycemia:
Aetiology: 3)Increased utilization
________
________
Hypo ________
________
3)Increased utilization
Asphyxia
Shock
Hypothermia
Sepsis
SYMPTOMS OF HYPOGLYCAEMIA
1)Due to catecholamine response to hypoglycaemia
____________
__________
__________
2)Due to effect of hypoglycaemia on the heart
__________
__________cardia
__________tension
Arrythmias
3)Signs of neuroglycopenia (decreased glucose in CNS)
Jitteriness/__________
Apnoea
__________
__________
Tachycardia
Sweating
Pallor
Cyanosis
Bradycardia
Hypotension
Tremors
Seizures
Coma
TREATMENT of hypoglycemia
Anticipation and prevention in high risk neonates.
Monitor glucose levels within ________ of birth, subsequently, ________ hr for the first ________ hrs, then every ________ hrs until ________ hrs. Keep a ________/________ chart.
Institute early feeding in stable neonates within ________ of age orally or via nasogastric tube.
1hr
1-2hr
6-8hrs
4-6hrs
24-48hrs.
Dextrostix/Glucometer
1hour
TREATMENT of Hypoglycemia
Symptomatic neonates to be given IV ____% __________ at ____ml/kg stat followed by a continuous infusion of 60mg/kg/24hrs
(using an infusion pump).
If seizures, start with ___ml/kg stat then maintenance.
Then measure blood glucose every _______ till level increases.
Aim to maintain glucose level at _________mg/dl.
___________ 0.1mg/kg IM can be given in emergency to mobilize glucose in emergency situation until IV glucose can be set up.
10% Dextrose ; 2ml/kg
4ml/kg
2hrs
Treatment of hypoglycemia
SEQUELAE
~____% of neonates with severe hypoglycaemia later develop _________ and _____________ .
30
mental retardation ; spastic quadriplegia
HYPERGLYCAEMIA
Definition : whole blood glucose level >________ mg/dl or plasma glucose value >_______mg/dl.
125mg/dl
145mg/dl.
Hyperglycemia
Aetiology
•______________________ glucose
•Neonates undergoing _______-__________ release
•Drugs eg _________
•Transient neonatal diabetes mellitus. Rare. Esp __________ infants.
•Onset of marked glycosuria, hyperglycaemia, polyuria, FTT, severe dehydration. Low insulin levels.
Treatment: ____________.
Exogenous parenteral
surgery ; epinerphrine
Theophylline; SGA infants.
Insulin.
ELECTROLYTE DERANGEMENTS
HYPOCALCAEMIA
Definition:Total serum calcium level <___mg/dl or ionized calcium level <___mg/dl.
7
4
Hypocalcemia
Neonates at risk
__________ newborns/ _______ Infants of diabetic mothers
__________________
Hypo___________
Ingestion of ________ feeds
___________ disease
EBT
Preterm ; VLBW
Birth Asphyxia
Hypoparathyroidism
low calcium ; Renal
CLINICAL MANIFESTATIONS of Hypocalcemia
Apnoea
__________
Jitteriness
Stridor/—————
___________
____________ spasms
Seizures
laryngospasm
Hyperreflexia
Carpopedal spasms
TREATMENT of Hypocalcemia
Give ____% ____________ IV 2ml/kg diluted with _________________ (1:1) slowly push over ______________ .
1ml of 10% Ca gluconate=_____mg of elemental Ca.
Monitor heart rate ideally with ______ or cardiac monitor.
Do not put Ca gluconate with _________ in the same infusion or ________ will precipitate (white precipitate).
No __________ or else ___________ occurs.
Dose can be repeated in 10mins if there is no clinical response to the first injection
10% ; Ca gluconate
equal volume of water ; 15-20mins
9mg ; ECG ; NaHCO3
CaHCO3 ; extravasation ; tissue necrosis
HYPOMAGNESAEMIA
Is a magnesium level <____mg/dl
Is most often associated with ____________.
Hence if there is concurrent untreated hypomagnesaemia, _______ persists until 50% ______________ 0.2ml/kg is given.
Infuse (slowly or rapidly?) .
Monitor ___________ .
Maintain with _______________ supplements.
1.2mg/dl
hypocalcaemia
seizure
Mag sulphate
slowly
heart rate
oral magnesium.
HYPONATRAEMIA
Is serum Na level <______mEq/l
Causes:
SIADH –plasma levels of ADH are inappropriately high for the concurrent low osmolality of the blood and are not suppressed by further dilution of body fluids. (_____ serum Na, _____ urinary Na, conc urine, _____ SG) eg _________________ , NNT, meningitis.
Tx: __________________ .
•Excessive administration of hyponatremic fluids.
•Excessive renal salt loss.
<130mEq/l
low ; high ; high
severe birth asphyxia
Restrict fluids.
HYPERNATRAEMIA
Is serum Na >_______ mEq/l
Causes:
_____________ feeds
____________
Diabetes ________—lack of ADH, hence cannot reabsorb water from the kidneys—polyuria and polydipsia, rapid loss of weight.
150 mEq/l
Hyperosmolar ;? Dehydration
Diabetes insipidus
NEONATAL SEIZURES
Definition: ___________ involuntary alteration of _______________ that may be manifested as _________________ , abnormal _______, _________, __________ or __________ activity.
Commonest in the newborn period ff : ___________ CNS (hence esp ________) increased vulnerability to excitation
Paroxysmal
brain function
loss of consciousness
motor ; sensory ; autonomic ; behavioral
immature ; VLBW
AETIOLOGY OF NEONATAL SEIZURES
•____________________ ) (HIE)
•CNS infections (____________ , ____________, brain _________)
•____________ ____________ (Intravent, subarachnoid, intracerebral, subdural)
•Metabolic
Hypoglycaemia Hypocalcaemia Hypomagnesaemia Hyponatraemia Hypernatraemia
Hypoxic Ischaemic Encephalopathy
meningitis, encephalitis, brain abcess
Intracranial haemorrhage
Aetiology of neonatal seizures
•CNS malformations (porencephaly etc) •Toxins
___________/___________ encephalopathy
Maternal drug withdrawal(heroin,cocaine
•Inborn errors of metabolism
____________,___________________
•Pyridoxine dependent seizures •Neurocutaneous syndromes
•Intrauterine infections (CMV, Toxo etc) •Idiopathic (10-30%)
Kernicterus/bilirubin
Phenylketonuria
Maple syrup urine disease
METABOLIC BONE DISEASE OF PREMATURITY
Occurs in >_____% of neonates weighing <1000g and in ____% of neonates weighing <1500g.
Aetiology
1) Inadequate _______ of _______ and _______ leading to poor mineralization.
2) Diminished _______ of _______ in VLBW.
50% ; 30%
intake ; Ca ; P04
synthesis ; Vit D
Metabolic bone disease of prematurity
Clinical features
Infant usually presents at ___________ of age with features of __________ viz:
Large ______________ due to poor skull development.
________________ of skull with side to side flattening (_____ shaped skull).
____________ of wrists, knees and ankles. Rickety __________
Fracture of ribs or long bones(pathological
2-4months ; rickets
anterior fontanelle
Frontal bossing ; box
Enlargement; rosary
Metabolic bone disease of prematurity
X-rays
__________ , __________ and __________ of the epiphyseal growth plates
__________ of skull, spine, ribs, scapular
Pathological fractures
Widening, cupping and fraying
Osteopenia
Metabolic bone disease of prematurity
Laboratory findings
Markedly raised ________________ ~>1000iu/l. Is earliest feature as bony x-ray changes are late.
Ca ________ or _________ .
P04 _________ or ________.
Vit D ___________.
alkaline phosphatase
normal or low
normal or low
low.
