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2metabolic Disorders

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11 views

2metabolic Disorders

Uploaded by

Amradin Shamil
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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METABOLIC DISORDER

By Ayele Mamo(Assistant professor of


pediatircs nursing )
Metabolic Disorders of the New-born

Objectives
At the end of this lesson the student
• Able to identify the metabolic disorders
• Able to describe the management of
Metabolic disorders.
Metabolic Disorders of the New-born
• Neonatal hypoglycemia
- Hypoglycemia is common metabolic problem in NICUs.
- The diagnosis of hypoglycemia depends on the clinical setting
but not solely on specific blood glucose level.
- For intervention or further evaluation, hypoglycemia could be
defined as blood glucose
level less than 40mg/dl.
Who should be
evaluated?
- Healthy term appropriate for gestational age (AGA) neonates
without any risk factors for hypoglycemia does not need
evaluation of their blood glucose level.
- But other preterm/premature/SGA neonates should checked
for hypoglycaemia.
Newborns at risk
• Newborns at risk for hypoglycemia that needs evaluation
include:
- Preterm infants
- Small for gestational age(SGA)
- Large for gestational age(LGA)
- Infants of diabetic mothers(IDM)
- Sick infants who require intensive care
 Post exchange blood transfusion

 Infants on intravenous fluids or parenteral fluids

 Infants whose mothers were treated with beta adrenergic or oral


hypoglycemic agents
 Intrapartum dextrose infusions

 Infants with polycythemia

 Hypothermic new-borns
Diagnosis
• It is based on

- Supportive perinatal history (risk factors).


- Signs and symptoms of hypoglycemia.
- Whole blood glucose less than 40mg/dl.
Management of neonatal hypoglycemia
A. Treatment of asymptomatic hypoglycemia
Feeding
- Offer breast feeding immediately.
- Check blood glucose30 minutes after feeding to insure normal
glucose level before the next feeding.
- If repeated blood glucose is > 40mg/dl continue to offer feedings at
2-3hours interval.
• Indications of IV infusions in asymptomatic hypoglycemia
(use same infusion as symptomatic hypoglycemia)
- Blood glucose < 25mg/dl.
- Blood glucose remains < 40mg/dl after one attempt of
feeding
If infant becomes symptomatic
- If oral feeding is contraindicated
• B. Treatment of symptomatic hypoglycemia

• Many neonates have asymptomatic (chemical) hypoglycemia.


In contrast to the frequency of chemical hypoglycemia, the
incidence of symptomatic hypoglycemia is highest in small for
gestational age infants.
• The exact incidence of symptomatic hypoglycemia has been
difficult to establish because many of the symptoms in
neonates occur together with other conditions.
• Immediate treatment
- Secure IV line
- Give 2ml/kg of 10% glucose IV bolus over one minute if signs
other than seizure
- Give 4 ml/kg of 10% glucose as a bolus over one minute if
seizure is present.
Continuous treatment
- Put on 10% glucose infusion at glucose infusion rate (GIR) of
6mg/kg/minutes (~ 90ml/kg/day).
- Recheck blood glucose after 30 minutes
Neonatal hyperglycemia
It is usually defined as whole blood glucose level >125
mg/dl.
Diagnosis of hyperglycemia will be made based on:
 Iatrogenic cuases

 Inability to suppress hepatic glucose production

- Perinatal risk factors ( like sepsis, prematurity)


 Clinical manifestations (weight loss, signs of
dehydration, polyuria).
 Laboratory (blood glucose >125 mg/dl., ketone &

glucose on urine analysis).


• Management of neonatal hyperglycemia
- Treat the neonate if in shock or dehydrated
accordingly
- Decrease glucose infusion by 2mg/kg/min
(30ml/kg/day) every 6 hrs and stop gradually if on
IV infusion.
- If the new-born was not on infusion put him/her on
5% glucose with rate of 4mg/kg/min.(~
60ml/kg/day)
- Look for and treat underlying causes

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