Fluid and Electrolytes

"In utero, glucose is the major metabolic fuel of the fetus. Glucose is transported across the placenta at 75% maternal concentration; maternal insulin is not transported across the placenta. Therefore, insulin is synthesized by the fetal pancreas at an early gestational age to maintain the environment of homeostasis."(Korones SB)

At birth, the maternal glucose supply is stopped once the umbilical cord is cut. In utero the fetus produces the insulin needed for demands of the maternal glucose. After birth, serum glucose initially decreases after birth necessitating frequent glucose checks. Infants have high glucose requirements due to the fact that glucose is their main fuel. The brain of the infant is large in proportion to overall body mass, thus further increasing glucose demand. Because of the high glucose requirements, and high energy requirements, infants are especially at risk for hypoglycemia.

Table 1. shows Lab Values determining Hypoglycemia levels:

Data from Bradburn and Schreiner.

The key in the treatment of infants or small children with hypoglycemia is early identification of those patients at risk. This, in turn, is followed by appropriate and immediate intervention. Treatment might include either D5/W or formula may be given. If the patient requires intravenous therapy, D10/W bolus of 2 to 4 mL/kg for neonates, and D25/W bolus of 2 to 4l/kg for an infant greater than 4 weeks of age. Infants and small children are at high risk for hypovolemia.

Hypoglycemia in infants

If hypoglycemia is left untreated, the consequences can be severe. The infant can present with slight continuous movements of extremities and an altered state of consciousness, which can lead to seizure activity and brain damage.(Bradburn & Schriener)