Intravenous Dextrose Administration Research Articles

Effectiveness of hospital-based oral dextrose gel in prevention and treatment of asymptomatic newborns at risk of hypoglycemia

Objective To evaluate the effectiveness of using hospital-based 40% dextrose gel (DG) in preventing and treating asymptomatic hypoglycemia in infants of diabetic mothers (IDM), large for gestational age (LGA), and macrosomic neonates. Methods A medical chart review was conducted to compare data between before (April 2018 to March 2019, epoch 1) and after (September 2020 to November 2021, epoch 2) 40% DG implementation. DG, prepared by the hospital pharmaceutical unit, was applied within 30–45 min after birth, and three additional doses could be repeated during the first 6 h of life in combination with early feeding. The primary outcome was the rate of intravenous dextrose administration. Secondary outcomes were the incidence of hypoglycemia, first capillary blood glucose concentrations, and the length of hospital stay. Results Six hundred forty-three at-risk newborns were included (320 before and 323 after implementation of DG). Maternal and neonatal baseline characteristics were not different between the two epochs. The incidence of hypoglycemia was not different (17.8% in before versus 14.6% in after implementation, p = 0.26). The rate of intravenous dextrose administration after DG implementation was significantly lower than that before DG implementation (3.4% versus 10.3%, p < 0.001, risk reduction ratio = 0.33, 95% CI = 0.17–0.64). The length of hospital stay was not different between the two epochs. Conclusions Implementing a protocol for administration of hospital-based 40% DG can reduce the need of intravenous dextrose administration among IDM, LGA and macrosomic neonates.

Bilateral Abducens Nerve Palsy and Nystagmus Resolved Upon Intravenous Dextrose Administration in Hypoglycemic Young Female: A Case Report and Review of the Literature

Hypoglycemia can cause a variety of neurological symptoms ranging from mild confusion to seizures and coma. The brain depends heavily on glucose as its main energetic resource, and a decrease in glucose levels can lead to impaired cerebral function. A 38-year-old female presented to the Emergency department with a history of headache, dizziness and asymmetric reactive pupils in addition to bilateral medial strabismus, nystagmus and photophobia. A non-contrast brain Computed Tomography scan was performed showed no significant radiological findings. Laboratory tests were within normal ranges except for a clinically significant hypoglycemia (level II). Intravenous dextrose was administered and strabismus gradually resolved, and headache subsided gradually within an hour. Hypoglycemic state should be investigated first in any patient with sudden neurological deficit.

PSUN370 Refractory Hypoglycemia Associated with a Metastatic Neuroendocrine Tumor Producing Multiple Hormones

Abstract Introduction Neuroendocrine tumors are rare. They are derived from hormone-producing and nerve cells mostly found in GI tract, lung or pancreas. In about half of the cases, work-up does not detect any tumor-related hormone secretion. Even less common, the tumor produces several hormones which may be associated with clinical symptoms. Clinical Case A frail 81-year-old male with mild-to-moderate dementia and no history of diabetes presented to the emergency department with complaints of generalized weakness, fatigue, weight loss, poor appetite, diarrhea and shortness of breath for 1-2 weeks. Physical examination was pertinent for cachexia, general pallor, dry oral mucosa and having heme positive stool. Initial laboratory work-up found anemia (Hg 5.8g/dl), low glucose of 43 mg/dL, hypoalbuminemia (Alb 1.9 gm/dL). CT angiogram of abdomen did not show any active bleed but showed incidental diffuse hepatic lesions favoring metastatic disease, pancreatic ductal dilatation and fluid-filled loops of small and large bowel compatible with enteritis. Subsequent endoscopy and colonoscopy were negative for malignancy. Findings of multiple liver lesions prompted a CT-guided liver biopsy which showed a metastatic, well differentiated neuroendocrine tumor WHO grade II/III with positive stains for chromogranin A, synaptophysin, cytokeratin Oscar (Ki-67 less than 20%). MRCP abdomen examination of pancreas showed no focal pancreatic lesions but was suboptimal due to motion artefacts and lack of contrast. Workup for the tumor revealed increased serum serotonin (772 ng/ml), increased 5-HIAA (3,175 ng/ml), increased chromogranin A (48,436 ng/ml) and an increased 24hr Urine 5-HIAA (162mg/24hr). Further workup for the persistent and hypoglycemia showed a random cortisol 24.6mcg/dl. During hypoglycemia, insulin and C-peptide levels were 4.3 uU/L and 1.4ng/ml indicating inappropriately "normal" insulin production consistent with an insulinoma. IGF 1 and IGF 2 levels were withing the normal range. The hypoglycemia was initially managed with continuous intravenous administration of dextrose and optimization of oral intake, glucagon and octreotide 50 mcg every 8 hours. However, the response to octreotide was insufficient and we were unable to wean the patient off the dextrose. Subsequently we started prednisone 20 mg oral daily and glucose tablets which allowed us to discontinue the intravenous dextrose and the octreotide. Patient was discharged home on hospice care. Conclusion Hypoglycemia is a potentially life-threatening condition necessitating prompt action including the administration of intravenous dextrose. The results of the workup indicate that the neuroendocrine tumor produced excessive amounts of both serotonin and insulin contributing to prolonged refractory hypoglycemia. Treatment of this rare condition is challenging and often empirical. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Risk factors, prevention and treatment of hypoglycaemia after hyperkalaemia in adult patients using intravenous insulin: An integrative review.

An integrative review was conducted to synthesize published evidence on the prevention and treatment of hypoglycaemia and patient risk factors, in adult patients treated for hyperkalaemia with intravenous insulin and dextrose. This review followed the framework by Whittemore and Knafl. Papers included were limited to English language studies involving participants who were aged 18 years and above and admitted in the inpatient acute care and emergency departments. The literature search was performed using five electronic databases (CINAHL, Embase, PubMed, Proquest and Cochrane). A total of 22 studies were included. Two main themes were derived-patient risk factors and prevention-intervention strategies. Five main patient risk factors were lower pretreatment blood glucose (<7 mmol/L), lower weight, renal insufficiencies, older age and nondiabetic. The four subthemes in the prevention-intervention strategies included (i) methods of administration and dosing of intravenous insulin and dextrose, (ii) frequency of blood glucose monitoring, (iii) education to healthcare professionals and (iv) rescue agents. Standardized computerized order sets and integrated decision tool that can advise appropriate prescription of a higher volume of dextrose or lower insulin dose according to patient risk factors, regular monitoring and reinforced education may prevent and mitigate the risk of hypoglycaemia.

Treatment of critical aluminum phosphide (rice tablet) poisoning with high-dose insulin: a case report

BackgroundAluminum phosphide (rice tablet) is a highly efficient agent for preserving grains against rodents and insects. It accounts for a large number of poisoning cases. Aluminum phosphide poisoning has a high mortality rate of about 90%, and to date, no antidote is available. It releases phosphine gas after exposure to moisture, and this reaction is catalyzed by the acidity of the stomach. Phosphine is then absorbed throughout the respiratory or gastrointestinal tracts and causes toxicity through inhibition of cytochrome c oxidase and formation of highly reactive free radicals. Treatment of patients with aluminum phosphide poisoning is supportive, including mechanical ventilation and vasopressors. The usage of infusion of glucose-insulin-potassium in rice tablet poisoning has been suggested, after its positive beneficial cardiac inotropic effects in patients with beta-blocker and calcium channel blocker poisoning.Case presentationWe report the case of a 30-year-old Iranian woman with critical aluminum phosphide poisoning, presented with hypotension and other signs of shock and severe metabolic acidosis, successfully treated with high-dose regular insulin and hypertonic dextrose and discharged from hospital in good condition. In contrast to our previous experiences, in which nearly all patients with critical aluminum phosphide poisoning died, this patient was saved with glucose-insulin-potassium.ConclusionAluminum phosphide poisoning has a high mortality rate, and to date, no antidote is available. Administration of high-dose intravenous regular insulin and dextrose is suggested as a potential life-saving treatment for patients with critical aluminum phosphide poisoning.

Evaluation of intraperitoneal administration of glucose solution using in the treatment of ketosis in dairy cows

Ketosis in high‐yielding dairy cows is the most common metabolic pathology during late dryness and early lactation. This work aims to establish the possibility and effectiveness of therapy for ketosis in dairy cows through the intraperitoneal injection of a 20% glucose solution. For the experiment, on days 21‐30 of lactation, two groups of black‐and‐white cows with a β‐hydroxybutyrate level above 1.0 mmol / l were formed. Animals of the first group (n = 10) were injected four times with an interval of 24 hours intraperitoneally with 1000 ml of 20% dextrose solution. Cows of the second group (n = 10) in a similar regimen were injected dextrose intravenously. Blood for research was obtained before the start of injections, after 5, 30 minutes, 1, 2, 3 hours after the first injection of the solution, and one day and seven days after the end of therapy. It was found that a single intravenous injection of dextrose during the first 5 minutes is accompanied by an increase in the concentration of the monosaccharide in the blood by 2.2 times (from 5.1 to 11.4 mmol / L; P &lt;0.001). The level decreases to the initial values within 1 hour, and intraperitoneal infusion does not cause hyperglycemia. A redistribution of protein fractions accompanies therapy of cows with ketosis: a decrease in the albumin‐globulin coefficient by 16.8% (P &lt;0.05) with intraperitoneal administration and by 26.9% (P &lt;0.01) with intravenous administration. The activity of AST after intracavitary injections of dextrose decreased by 36.5% (P &lt;0.05). The loading of erythrocytes with substances of low and medium molecular weight was 19.4% (P &lt;0.05) with the intraperitoneal injection. It was not observed with the intravascular route of administration. The morphological composition of blood after intravenous administration of dextrose was characterized by an increase in the level of leukocytes by 34.8% (P &lt;0.05), a decrease in erythrocytes by 11.9% (P &lt;0.05), hemoglobin by 11.6% (P &lt;0, 05), hematocrit by 12.3% (P &lt;0.05). Therapy via intraperitoneal injection did not cause pronounced changes in these parameters. The intravenous administration of glucose promoted a more rapid elimination of ketone bodies, which decreased by 2 times one day after the end of therapy (P &lt;0.05), but after 7 days, their level began to increase again (by 21.1%). It did not have significant differences with indicators at the time of diagnosis. Intraperitoneal infusions were accompanied by a slight decrease (by 16.3%) in the level of β‐hydroxybutyrate one day after the end of therapy, followed by a pronounced decrease in the concentration of ketones by day 7 (2.3 times; P &lt;0.01). The dynamics of fructosamine indicate that intracavitary injections do not cause glycosylation of plasma proteins, while intravenous infusions increase the values by 37.0 ‐ 39.4% (P &lt;0.001). Thus, intraperitoneal administration of glucose during ketosis in dairy cows has a more favorable effect on the morphobiochemical composition of the blood and provides a more prolonged therapeutic effect.

Variations in New Zealand and Australian guidelines for the management of neonatal hypoglycaemia: A secondary analysis from the hypoglycaemia Prevention with Oral Dextrose gel Trial (hPOD).

We observed wide variation in the management of babies at risk of hypoglycaemia who participated in the hPOD (hypoglycaemia Prevention with Oral Dextrose gel) multicentre trial of prophylactic dextrose gel. The aim of this study was to identify whether this may be due to variations in the clinical guidelines used by participating hospitals. Guidelines for management of neonatal hypoglycaemia used by participating hospitals were reviewed. Recommendations regarding definition, risk factors, monitoring and treatment were compared between countries, hospital type (tertiary or secondary) and neonatal intensive care unit size (≤12 cots and >12 cots). The 18 hospitals used 20 guidelines. The recommended diagnostic threshold for hypoglycaemia ranged from <2.0 mmol/L to <2.6 mmol/L, and glucose oxidase method of testing was recommended in seven (47%) of 15 guidelines. There was broad agreement about which infants should be monitored. Oral dextrose was the recommended first line of treatment in 17 of 20 guidelines, but the glucose threshold at which this should be used varied (≤2.6 mmol/L in New Zealand, 1.5-2.6 mmol/L in Australia). Re-checking blood glucose concentrations after oral dextrose was recommended at 30 min in most (10/11, 91%) New Zealand guidelines but at 60 min in most (4/6, 67%) Australian guidelines. There was greatest variation in recommended thresholds for referral to paediatric services or neonatal intensive care unit, and administration of intravenous dextrose. There were no significant differences between guidelines used by tertiary and secondary hospitals, or large and small hospitals. There is wide variation in guideline recommendations for the management of neonatal hypoglycaemia across New Zealand and Australian neonatal units.

A Better World in the Future: Part 2

A Better World in the Future: Part 2

Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis.

BackgroundIt is reported that postoperative nausea and vomiting, common general anesthesia complications, may be prevented by perioperative intravenous dextrose administration, but with controversial clinical effectiveness.ObjectiveTo evaluate perioperative intravenous dextrose for preventing postoperative nausea and vomiting through a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.Data sourcesMEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science, clinicaltrials.gov, and the University Hospital Medical Information Network Clinical Trials Registry were searched from inception until 22 June 2019.Eligibility criteriaTrials investigating intravenous dextrose effects vs. placebos on postoperative nausea and vomiting in patients who underwent general anesthesia.ResultsEleven trials (1,250 patients) were included. All participants were ASA1-2. The nine trials included laparoscopic surgeries, and 92.2% of the participants were women. The timing of dextrose infusion was before, during, and after surgery in three, five, and three trials, respectively. Our results revealed intravenous dextrose administration significantly reduced postoperative nausea, but not vomiting, during early and late postoperative periods (risk ratio [95% confidence interval], early nausea: 0.76 [0.59–0.99], late nausea: 0.65 [0.48–0.89]; early vomiting: 1.00 [0.81–1.25], late vomiting: 0.96 [0.43–2.16]). Evidence quality was downgraded to low because the trial sequential analysis indicated more trials are needed for firm conclusions.ConclusionsCompared with placebos, perioperative intravenous dextrose administration may decrease postoperative nausea but not vomiting.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000030901).

Glucose related endocrine and metabolic responses following bolus intravenous hypertonic dextrose administration in Iranian fat-tailed ewes at different pre and post parturition periods

Providing glucose as primary metabolic fuel for maintenance, foetal growth and milk production may be considered necessary for protection against negative energy balance and metabolic disorders. Five adult Ghezel ewes were selected 4 weeks before their parturition and followed at 2 weeks before, 2 and 4 weeks and 2, 3 and 4 months after parturition. Dextrose 50% was administered at 500 mg/kg, 10 mL/kg/hour, and blood samples were collected from all ewes prior to and 1, 2, 3 and 4 hours after 50% dextrose infusion. Serum levels of glucose, beta-hydroxybutyric acid, non-esterified fatty acids, cholesterol, triglyceride, high, low and very low density lipoproteins, insulin, triiodothyronine, thyroxine, prolactin, cortisol and insulin like growth factor-1 were evaluated. Glucose and insulin were increased significantly and immediately following intravenous dextrose administration at all studied periods. The levels of beta-hydroxybutyric acid and non-esterified fatty acids were significantly decreased following dextrose infusion at all periods. Triiodothyronine was decreased in pregnant ewes and increased in non-pregnant, lactating ones. The significant increasing cortisol patterns were detected at 2 and 4 weeks before and 2 and 4 weeks after parturition following dextrose administrations. The decreasing patterns of insulin like growth factor-1 were seen in all studied periods. Prolactin was significantly increased following dextrose administration at 4 and 2 weeks before and 2 weeks after parturition. Bolus intravenous hypertonic dextrose administration could induce the obvious endocrine and metabolic responses in Ghezel ewes via providing a source of energy and the glucose is an important direct controller of metabolic interactions in Ghezel ewes.

Hypoglycaemic crisis induced by non-islet cell tumours in two dogs

Two dogs were admitted for the diagnosis and treatment of neoplasia (a hepatic and a mammary tumour, respectively), lethargy, quadriparesis and abnormal mentation with hypoglycaemia. The blood analyses showed severe hypoglycaemia (1.32 and 1.60 mmol/l, respectively). Although prompt treatment, including intravenous administration of dextrose, was initiated, the blood glucose concentrations were not restored to a normal range. After the diagnostic procedures, no aetiology other than the hepatic tumour identified by the abdominal radiography and ultrasonography, and a mammary tumour that might have caused the hypoglycaemia, were identified. Because there was a high suspicion of non-islet cell tumour-induced hypoglycaemia as a paraneoplastic syndrome, the dogs underwent a hepatic lobectomy and total mastectomy with an ovariohysterectomy, respectively. Within 12 hours after surgery, the blood glucose concentrations of both cases had normalised, even without the administration of dextrose. The histopathological examinations identified a hepatocellular adenoma and a mammary carcinoma, respectively. The endocrine analysis of the serum at admission revealed low serum insulin concentrations (&amp;lt; 1.44 pmol/l) and high serum concentrations of insulin-like growth factor 2 in both dogs. Therefore, the diagnosis in both dogs was confirmed to be non-islet cell tumour-induced hypoglycaemia. Both dogs remained alive without the recurrence of hypoglycaemia 24 months later. Previously, the administration of intravenous dextrose has been considered as the initial treatment in dogs with hypoglycaemia; however, this can temporarily ameliorate the clinical signs related to the non-islet cell tumour-induced hypoglycaemia and help the anaesthesia for the surgical tumour resection as an emergency. Therefore, the definitive treatment of non-islet cell tumour-induced hypoglycaemia might be rapid surgical intervention, which can be associated with good prognosis in dogs with severe non-islet cell tumour-induced hypoglycaemia.

Insulinoma: A Diagnostic Challenge!

Insulinoma is a common tumour arising from islets of Langerhans. Patients with insulinomas present with neuroglycopenic symptoms such as repeated episodes of headache, blurred vision, diplopia and lethargy especially with fasting or exercise. Seizures, coma and permanent brain damage results from severe hypoglycaemia. The present report is of a female who got admitted with the chief complaints of swaying on to one side since one month and slurring of speech, seizures and becoming drowsy for four days. Her laboratory values indicated repeated episodes of hypoglycaemia in spite of repeated administration of intravenous dextrose. A CT scan of pancreas revealed insulinoma and was treated by surgical resection. After surgery, patient’s symptoms subsided and she recovered well. The clinical manifestations of insulinoma mimic features of diabetes mellitus and neuropsychiatric disorders, hence a thorough investigation needs to be done to confirm the diagnosis.

The Effects of Skin-to-Skin Care on Late Preterm and Term Infants At-Risk for Neonatal Hypoglycemia

Background: Neonatal hypoglycemia (NH) is a common disorder affecting 5 to 15% of otherwise healthy infants, such as late preterm, small or large for gestational age, or born to mothers with diabetes. Early management of NH in these at-risk infants is often achieved with administration of formula and/or intravenous (IV) dextrose, which may potentially impair normal metabolic adaptation. Multiple studies have demonstrated that early infant skin-to-skin contact with …

The effect of intravenous dextrose administration for prevention of post-operative nausea and vomiting after laparoscopic cholecystectomy: A double-blind, randomised controlled trial.

Background and Aims:Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC.Methods:In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery.Results:There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores (P < 0.05). A low negative correlation coefficient was found (r = −0.394, P < 0.001) between blood glucose levels and nausea scores upon PACU arrival. Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: −0.87, odds ratio = 0.42, 95% confidence interval: 0.28–0.64).Conclusion:Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC.

Hypoglycemic Encephalopathy: A Neurologic Manifestation of Hypoglycemia

Case Presentation: An 81-year-old man with insulin-treated type 2 diabetes who had been non-compliant with his insulin therapy was taken to the emergency department with altered consciousness of unknown duration. Emergency medical services were called when he was found unresponsive at home by his friend. Paramedics found him comatose and hypoglycemic on the scene with a blood glucose level (BGL) of 1.1 mmol/L. His BGL normalized following administration of intramuscular glucagon and intravenous dextrose. Despite this, he had no neurologic recovery. No toxic or metabolic causes of his altered conscious state were identified and blood gas analysis did not reveal any evidence of hypoxemia. Computed tomography scan of the brain was unremarkable. He was intubated and was transferred to the intensive care unit. Magnetic resonance imaging (MRI) revealed abnormal diffusion restriction involving the cerebral cortex in multiple locations (Figure 1), with the changes most confluent and pronounced in the right parieto-occipital cortex. These findings were consistent with hypoglycemic encephalopathy. He continued to have no neurologic improvement after 6 days of hospital admission. After discussion with the patient’s family, he was transitioned to comfort care given his poor prognosis. He died on the ninth hospital day. Hypoglycemic encephalopathy is a neurologic manifestation of hypoglycemia. The clinical course of this condition is variable, ranging from completely reversible neurologic deficits to irreversible coma [1,2]. Neuropathological studies have demonstrated that the cerebral cortex, hippocampus and basal ganglia are the commonly affected sites in severe hypoglycemia [2,3]. MRI findings in hypoglycemic encephalopathy include diffusion restriction at characteristic locations [2]. Poor prognostic factors in patients with hypoglycemic encephalopathy may include diffuse and extensive cortical involvement, prolonged and profoundhypoglycemia, normal or higher body temperature, and a low lactic acid level during hypoglycemia [1,2].

Antenatal breast milk expression by women with diabetes for improving infant outcomes.

Some women with diabetes in pregnancy are encouraged to express and store colostrum prior to birthing. Following birth, the breastfed infant may be given the stored colostrum to minimise the use of artificial formula or intravenous dextrose administration if correction of hypoglycaemia is required. However, findings from observational studies suggest that antenatal breast milk expression may stimulate labour earlier than expected and increase admissions to special care nurseries for correction of neonatal hypoglycaemia. To evaluate the benefits and harms of the expression and storage of breast milk during late pregnancy by women with diabetes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2014). All published and unpublished randomised controlled trials comparing antenatal breast milk expressing with not expressing, by pregnant women with diabetes (pre-existing or gestational) and a singleton pregnancy. Two review authors independently evaluated reports identified by the search strategy. There were no published or unpublished randomised controlled trials comparing antenatal expressing with not expressing. One randomised trial is currently underway. There is no high level systematic evidence to inform the safety and efficacy of the practice of expressing and storing breast milk during pregnancy.

Intravenous Dextrose Administration Reduces Postoperative Antiemetic Rescue Treatment Requirements and Postanesthesia Care Unit Length of Stay

Intravenous Dextrose Administration Reduces Postoperative Antiemetic Rescue Treatment Requirements and Postanesthesia Care Unit Length of Stay

The Relationship of Intravenous Dextrose Administration During Emergence from Anesthesia to Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) may occur despite antiemetic prophylaxis and is associated with unanticipated hospital admission, financial impact, and patient dissatisfaction. Previous studies have shown variable impact of IV dextrose on PONV. We sought to determine the relationship of IV dextrose administered during emergence from anesthesia to PONV. This was a prospective, double-blind randomized placebo-controlled trial. Adult female ASA physical status I and II nondiabetic patients scheduled for outpatient gynecologic, urologic, or breast surgery were randomly assigned to infusion of 250 mL lactated Ringer's solution (group P; n = 75) or dextrose 5% in lactated Ringer's solution (group D; n = 87) over 2 hours beginning with surgical closing. Blood glucose was determined using a point-of-care device before transfer to the operating room, in the operating room immediately before study fluid infusion, and in the recovery room after study fluid infusion. No antiemetics were given before arrival in the recovery room. PONV scores were recorded at 0, 30, 60, and 120 minutes and 24 hours after arrival in the recovery room. Medication administration was recorded. Data from 162 patients with normal baseline blood glucose were analyzed. There were no significant intergroup differences in demographics, history of PONV, or tobacco use. There was no significant intergroup difference in PONV during the first 2 hours after anesthesia (group D 52.9% vs group P 46.7%; difference, 6.2%; 95% confidence interval [CI], -9.2% to 21.6%; P = 0.43). Patients in groups D or P who developed PONV within 2 hours of anesthesia had similar number of severity scores ≥1 during recovery stay (1.5 vs 1.0; difference, 0; 95% CI, 0%-0%; P = 0.93); and similar proportions of: PONV onset within 30 minutes of recovery room arrival (65.2% vs 57.1%; difference, 8.1%; 95% CI, -13.1% to 28.8%; P = 0.46); more than 1 dose of antiemetic medication (56.5% vs 62.9%; difference, 6.3%; 95% CI, -26.9% to 15.1%; P= 0.65); or more than 1 class of antiemetic medication (50.0% vs 54.3%; difference, 4.3%; 95% CI, -25.5% to 17.4%; P = 0.82). The administration of dextrose during emergence from anesthesia was not associated with a difference in the incidence of PONV exceeding 20% or in the severity of PONV in the first 2 hours after anesthesia. The relationship between PONV and the optimal dose and timing of IV dextrose administration remains unclear and may warrant further study.

Intravenous Dextrose Administration Reduces Postoperative Antiemetic Rescue Treatment Requirements and Postanesthesia Care Unit Length of Stay

Postoperative nausea and vomiting (PONV) remains the most common postoperative complication, and causes decreased patient satisfaction, prolonged postoperative hospital stays, and unanticipated admission. There are limited data that indicate that dextrose may reduce nausea and vomiting. In this trial, we attempted to determine whether the rate of PONV can be decreased by postoperative administration of IV dextrose bolus. To test the effect of postoperative dextrose administration on PONV rates, we conducted a double-blind, randomized, placebo-controlled trial. We enrolled 62 nondiabetic, ASA class I or II nonsmoking outpatients scheduled for gynecologic laparoscopic and hysteroscopic procedures. Patients were randomized into 2 groups: the treatment group received dextrose 5% in Ringer lactate solution, and the control (placebo) group received Ringer lactate solution given immediately after surgery. All patients underwent a standardized general anesthesia and received 1 dose of antiemetic a half hour before emergence from anesthesia. PONV scores, antiemetic rescue medications, narcotic consumption, and discharge time were recorded in the postanesthesia care unit (PACU) in half-hour intervals. The 2 groups were similar with regard to age, weight, anxiety scores, prior PONV, non per os status, presurgical glucose, anesthetic duration, intraoperative narcotic use, and total weight-based fluid volume received. Postoperative nausea scores were not significantly different in the dextrose group compared with the control group (P > 0.05) after Bonferroni correction for repeated measurements over time. However, patients who received dextrose 5% in Ringer lactate solution consumed less rescue antiemetic medications (ratio mean difference, 0.56; 95% confidence interval, 0.39-0.82; P = 0.02), and had a shorter length of stay in the PACU (ratio mean difference, 0.80; 95% confidence interval, 0.66-0.97; P = 0.03) compared with patients in the control group. In this trial, postanesthesia IV dextrose administration resulted in improved PONV management as defined by reductions in antiemetic rescue medication requirements and PACU length of stay that are worthy of further study. In light of its ease, low risk, and benefit to patient care and satisfaction, this therapeutic modality could be considered.

Index of Suspicion in The Nursery

A 2½-day-old full term infant born by induced vaginal delivery to a 33-year-old G1P1 female with an uncomplicated pregnancy presents to the emergency department because of feeding refusal and severe apnea. She is found to have severe hypoglycemia and dehydration, but despite resuscitative efforts dies. Before presentation, at home the infant spit up yellow mucus-like material and had several episodes described as “lethargy” with stiffening of the legs. Appropriately vigorous at birth (Apgar scores of 9 at both 1 and 5 minutes), the infant received an initial feeding at the breast at 1 to 2 hours after birth. However, during the mother and infant's hospital stay, subsequent feedings were erratic with markedly decreased interest in feeding and decreased vigor noted in the nursery. A sepsis evaluation in the nursery was negative. Tests including a second newborn screen and urine organic acids were sent to the lab and the infant went home with results pending. A 39-week, 4.4-kg, male infant born to a 29-year-old primigravida woman with unremarkable serologies is admitted to the special care nursery due to tachypnea and persistent hypoglycemia. The pregnancy was complicated by fetal macrosomia, although the mother had a normal 1-hour glucose tolerance test. Delivery was complicated by fetal macrosomia requiring primary C-section and thick meconium at the time of artificial rupture of membranes. The patient cried at the abdomen and did not require further resuscitation. Blood sugar checked at 15 minutes after birth due to macrosomia was 43 and a repeat at 30 minutes after birth was 33. The patient was given oral formula with repeat dextrostix of 30 at 1 hour of age, prompting admission to nursery for intravenous dextrose administration and further evaluation. Admission weight is 4,470 g (>90%), length 56 cm (>90%), and head circumference 38 cm (>90%). Examination showed tachypnea with …