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Slides Pediatric Nursing Hypoglycemia Diagnosis Management

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Princess Isabella Kintanar Suelan
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15 views13 pages

Slides Pediatric Nursing Hypoglycemia Diagnosis Management

Uploaded by

Princess Isabella Kintanar Suelan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Hypoglycemia:

Diagnosis and Management


With Amy J. Howells, PhD, CPNP-AC/PC
Presentation

Neurogenic symptoms Neuroglycopenic symptoms Nonspecific symptoms

Blood glucose Blood glucose


< 55–60 mg/dL < 50 mg/dL

Neurogenic symptoms typically occur


before neuroglycopenic symptoms.
Neurogenic symptoms Neuroglycopenic symptoms Nonspecific symptoms
Insufficient glucose levels in Infants and toddlers: symptoms
Sympathetic nervous system
the brain are frequently nonspecific

Sweating Lethargy Irritability


Tremors Confusion Lethargy
Palpitations Irritability Poor feeding
Tachycardia Uncharacteristic behavior Cyanosis
Hunger Weakness Tremors
Paresthesias Loss of consciousness Jitteriness
Pallor Seizure Hypothermia
Coma Hypotonia
Tachypnea
Apnea
May present with hypoglycemic seizure as first indication
Diagnosis

Neonates suspected to be at high risk at:

Symptoms of Large for Perinatal stress Premature


hypoglycemia gestational age
(likewise small for
gestational age)
Neonates suspected to be at high risk at:

Infant of a Family history Congenital Abnormal facies


diabetic mother syndrome
Any infant or younger child who has a documented blood glucose level < 60 mg/dL
Management

The goal is to achieve rapid normalization of blood glucose levels.

May use

Oral carbohydrates Intravenous


Child with normal (IV) glucose
consciousness Child with altered
consciousness
Children who Are Conscious

Rapid-acting carbohydrates given orally

15 g for children = = =
120 mL A tube of 4 glucose
(4 ounces) glucose gel tablets
of juice

0.2 g/kg for infants


Children with Altered Consciousness

Obtain IV access and


administer IV dextrose.

2 mL/kg of 10% dextrose IV


Initial bolus = (0.2 g dextrose/kg of body weight)

If glucose fails to increase after 15 minutes, repeat the dose.

Dextrose infusion Glucose infusion rate (GIR) for Typically 10%


infants: 5–6 mg/kg/minute dextrose IV
Start infusion after the initial bolus
to prevent further hypoglycemia.
=
GIR for older children: Typically 5%
2–3 mg/kg/minute dextrose IV
Obtain IV access and
If IV access cannot be
administer IV dextrose
obtained

Glucagon 0.5 mg for < 25 kg or


Glucagon can be used. = 1 mg for > 25 kg given intramuscularly

Only effective for insulin-mediated hypoglycemia


Includes: hyperinsulinism, accidental insulin administration
or overdose, or sulfonylurea ingestion

Thus, glucagon is a useful tool for diagnosing the cause


of hypoglycemia.
Glucose Infusion Rate

mL
dextrose percentage x rate of infusion
hr
GIR =
6 x weight kg

Infants: 5–6 mg/kg/minute Older children: 2–3 mg/kg/minute


Typically 10% dextrose IV Typically 5% dextrose IV
Monitoring

Blood glucose levels should be monitored until…

…they are > 70 mg/dL

...every 15 minutes

…they are stable.

...every 1 hour

…they are stable for several hours.

...every 4 hours
Long term plan once Follow up by
cause is determined endocrinologist

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