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OF BLOOD SUGAR AND CLUELESSNESS

03 Jul

Neonatal emergencies really make pediatricians and neonatologists high-strung as this event in the baby’s life significantly affects his future. One of those emergencies is a problem with baby’s blood sugar, whether it is elevation or depletion. Either way will produce a grave sequela if not immediately corrected.

The cut off value whether to consider the blood sugar low or high is quite controversial. Hyperglycemia (elevation of blood sugar) may be considered when the reading is above 120 mg/dL; but others may use higher cut off value. In one study, the ceiling value was 140 mg/dL. That study mentioned that any blood sugar elevation above 140mg/dL within the first week of the baby’s life is highly associated with infant mortality. (Of course, this elevation is not a product of medical and nursing error). But the study does not state whether higher value means greater risk of dying and vice versa. In my limited practice, I have noticed that this study finding is true in almost all cases, except for one. Elevation of blood sugar may mean hormonal imbalance, but most commonly an infectious process.

Hypoglycemia (low blood sugar) also has controversial cut off value. Some use 50 mg/dL, others use 40 mg/dL and another article uses operational cut off value at 36mg/dL.  As with hyperglycemia, hypoglycemia as well has unwanted sequela. Baby can either be asymptomatic or have life-threatening nervous system or cardiopulmonary disturbances. Some of the symptoms include lethargy, cyanosis (bluish discoloration), apnea (cessation of breathing), jitteriness/seizures, congestive heart failure, or hypothermia. Clinical manifestations of hypoglycemia with the activation of autonomic nervous system include anxiety and tremulousness, diaphoresis (sweating), tachycardia, palor, hunger, nausea and vomiting. When the central nervous system is depleted of blood sugar (hypoglycorrhachia) it may manifest with the following

  • Headache
  • Mental confusion, staring, behavioral changes, difficulty concentrating
  • Visual disturbances (eg, decreased acuity, diplopia)
  • Dysarthria
  • Seizures
  • Ataxia, somnolence, coma
  • Stroke (hemiplegia, aphasia), paresthesias, dizziness, amnesia, decerebrate or decorticate posturing

(reference: http://emedicine.medscape.com/article/802334-clinical#a0256)

During fetal life, glucose is a very significant fuel for development, especially that of the brain. If glucose level is maintained adequate, it brings about normal levels of the substance insulin-like growth II (IGF-2). The latter, IGF-2, promotes increase in the number of neurons, also increase in dendritic-axonal arborizations, which thus means faster transfer of neuronic impulse. Depletion then of the brain of blood sugar brings about the opposite, and may thus lead to a patient with cognitive-impairment. Babies who had intrauterine growth restrictions (IUGR) during pregnancy are often the victims of this.

Hypoglycemia may be caused by a lot of factors. It may be due to lack of supply and storage in the liver (eg, prematures, IUGRs); may be caused by excessive consumption during stressful conditions (eg, sepsis, asphyxia) or maybe due to excessive insulin production (infants of diabetic mothers, large for gestational age).

Once my patient, your baby, is detected to have a low blood sugar reading, you now understand why I get so hyped to have it corrected at once. I do not only want your baby not to have seizures… I don’t want your baby to grow up CLUELESS.

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Posted by on July 3, 2013 in neonates

 

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