Glucose 250, MD Notified: A Case Report.

Abstract

Background: Hyperglycemia is common in neonates. Insulin therapy is used to treat hyperglycemia. Threshold for treating hyperglycemia varies among the neonatal practitioners. The renal threshold for glucose is 180 mg/dl, so most practitioners wait on insulin therapy till the serum glucose level reaches 180 mg/dl. We describe a case of a neonatal hyperglycemia of greater than 250 mg/dl that was successfully managed conservatively. Clinical Findings: The neonate, who was depressed at birth, was noted to have high serum glucose levels soon after birth. Serial glucose levels within first six hours of life were persistently above 200 mg/dl. The serum cortisol was normal while serum insulin was low. Infant was provided a low rate of intravenous glucose without giving any insulin. The serum glucose declined to normal levels within 24 hours. Primary diagnosis: Stress-induced transitional hyperglycemia. Interventions: We performed a serial monitoring on serum glucose and provided intravenous dextrose solution at a very low rate. The glucose infusion rate used was only 2.6 mg/kg/min. We were able to bring down the serum glucose to normal ranges conservatively without using any insulin therapy. Outcomes: Infant responded to conservative management and serum glucose was normalized within 24-hours. Practical Recommendations: Stress-induced hyperglycemia soon after birth is transitional and could be managed conservatively without insulin therapy.