Neonatal Hypoglycemia Medication

Updated: Apr 16, 2017
  • Author: Hilarie Cranmer, MD, MPH, FACEP; Chief Editor: George T Griffing, MD  more...
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Medication

Medication Summary

Hypoglycemia should be treated as soon as possible to prevent complications of neurologic damage. Early feeding of the newborn with breast milk or formula is encouraged. For those unable to drink, a nasogastric tube can be used. The mainstay of therapy for children that are alert with intact airway protection includes orange juice at 20 mL/kg.

For those who cannot protect their airway or are unable to drink, nasogastric, intramuscular, intraosseous, or IV routes can be employed for the following drugs used to raise glucose levels: dextrose, glucagon, diazoxide, and octreotide. Case reports have shown that nifedipine may help to maintain normoglycemia in children with PHHI.

Cortisol should not be used, because it has minimal acute benefit and may delay the diagnosis of the cause of hypoglycemia. Cortisol stimulates gluconeogenesis and causes decreased use of glucose, which leads to overall elevated blood glucose and may mask the true cause of hypoglycemia.

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Anti-hypoglycemic Agents

Class Summary

These agents elevate blood glucose levels.

Dextrose

Dextrose is the treatment of choice. It is absorbed from the intestine, resulting in a rapid increase in blood glucose concentration when administered orally. Give IV dextrose to infants of diabetic mothers with transient neonatal hyperinsulinemia for several days until hyperinsulinemia abates. Avoid hyperglycemia evoking prompt insulin release, which may produce rebound hypoglycemia. SGA infants and those with maternal toxemia or perinatal asphyxia require dextrose IV infusion rates of more than 20 mg/kg/minute to control levels. Treatment may be necessary for 2-4 weeks.

Diazoxide (Proglycem)

Diazoxide increases blood glucose by inhibiting pancreatic insulin release and possibly through an extrapancreatic effect. A hyperglycemic effect starts within an hour and usually lasts a maximum of 8 hours with normal renal function. Diazoxide is reportedly effective in SGA infants and in those with maternal toxemia or perinatal asphyxia.

Octreotide (Sandostatin)

Octreotide is a long-acting analog of somatostatin that suppresses insulin secretion for the short-term management of hypoglycemia.

Glucagon (Glucagon Emergency Kit, GlucaGen)

Glucagon may be used to treat hypoglycemia secondary to hyperinsulinemia and can be administered to patients without initial IV access. Each mL contains 1 mg (ie, 1 U). Maximal glucose concentration occurs between 5-20 minutes after IV administration and about 30 minutes after intramuscular (IM) administration.

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