Hypoglycaemia

CHAPTER 11 Hypoglycaemia



Mark Davies, David Cartwright



Background


Hypoglycaemia is defined as a blood sugar level (BSL) of <2.6 mmol/L as measured by a bedside glucometer or a blood gas machine. 1 mmol/L = 18 mg/dL.


Blood glucose assessments should be routinely undertaken on premature infants, infants whose birth weight is <10th percentile for their gestational age, infants of diabetic mothers, and other macrosomic babies — at 1 hour, 2 hours and 4 hours of age, then every 4 hours for 24 hours until stable.


• The laboratory blood glucose is often higher than the bedside measurement.

• Any low or borderline BSL should be confirmed with a laboratory or a blood gas machine measurement.


Management


The basic principle of managing hypoglycaemia is to give the baby more sugar than it is currently getting.


Options for treatment are:


If BSL is 2.0–2.5 mmol/L:


1. Feed with milk (not glucose water).

2. Feed more frequently, e.g. every 1–2 hours if necessary.
If BSL is <2.0 mmol/L:
3. Start 10% glucose IV at 60 to 75 mL/kg/day.

4. Increase the dextrose infusion rate or concentration.

• Usually just increasing the amount of dextrose infused is enough — i.e either:
— increase the rate of infusion (e.g. from 0 to 60 mL/kg/day, or from 60 to 80); or

— increase the strength of the infusion (e.g. from 10% to 12% dextrose, then 14%, 18%). If you need to give more than 12% dextrose, use a central line or umbilical venous line.
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Jul 18, 2016 | Posted by in PEDIATRICS | Comments Off on Hypoglycaemia

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