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4 - Hypoglycaemia in infant of a diabetic mother

Published online by Cambridge University Press:  15 February 2010

Amanda Ogilvy-Stuart
Affiliation:
University of Cambridge
Paula Midgley
Affiliation:
University of Edinburgh
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Summary

Clinical presentation

  • Hypoglycaemia in infants of diabetic mothers should be anticipated and all infants should have early and regular glucose measurements until these are stable.

  • Hypoglycaemia may be asymptomatic or symptomatic.

Approach to the problem

  • Expectant management in all infants of diabetic mothers.

  • Early enteral feeds.

  • Regular (1–2 hourly) blood sugar measurements for first 12 h.

Differential diagnosis

Other causes of hypoglycaemia (see Chapter 2).

Investigations

  • Blood glucose level.

  • Other investigations for hypoglycaemia are not usually required unless hypoglycaemia is persistent.

  • Calcium and magnesium levels are required in symptomatic babies as symptoms overlap.

  • Haematocrit should be assessed if the baby appears plethoric or blood sugar is difficult to control (dilutional exchange transfusion may be required if the baby is polycythaemic).

Management

Immediate

  • If able to tolerate enteral feeds, increase the volume and frequency of the feeds.

  • If unable to tolerate feeds, commence an intravenous (IV) infusion and titrate the quantity of glucose to maintain the blood glucose concentration >2.6 mmol/L. Use a higher concentration of glucose via a central line (silastic long-line or umbilical venous catheter) rather than excess volumes of 10% dextrose as the latter is likely to result in fluid overload and hyponatraemia.

  • If IV access is difficult, intramuscular glucagon (100–200 µg/kg/dose) or buccal hypostop (40% glucose polymer, 1 mL/kg) may restore euglycaemia and buy time to achieve vascular access.

  • […]

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2006

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