TYK368
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
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.