A 5 week-old, 3 kg, full-term female infant presents to the ER with new onset
seizures in the setting of hypoglycemia related to sepsis. She is brought to the
operating room for an exploratory laparotomy. The intravenous line is
disconnected from dextrose-containing intravenous fluids for approximately one
hour in the pre-anesthesia holding area. After induction of anesthesia the first
glucose reading is 25 mg/dL. What would be the BEST initial intervention?
a) Restart maintenance D10 ½ NS at previous infusion rate of 12 mL/hr
b) Bolus 6 mL of D50W peripherally and restart infusion rate of 12 mL/hr
c) Bolus 6 mL of D10W centrally and restart infusion rate of 12 mL/hr
d) Recheck glucose prior to intervening
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Answer
Answer c. Although it is reasonable to verify lab tests in question, hypoglycemia
poses significant long-term risks to this patient and treatment should not be
delayed pending repeat testing. Optimal treatment involves two components: (1)
correction of the acute defect, and (2) prevention of recurrence with initiation of
glucose-containing fluids. In infants under 2 months old, D10W is the preferred
treatment (2-5 mL/kg) due to the risk of intraventricular hemorrhage caused by
hyperosmolarity of D25W and D50W. D10W or D25W may be used in patients 2
months to 2 years, and any of the three fluids is appropriate over 2 years of age.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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