Transitioning from IV Dextrose to enteral feeds following hypoglycaemia

[ali]

Hello 99Nicu,

Recently we have had a number of infants who have required IV Dextrose infusions following episodes of low sugars. Does anyone know of or use a specific guideline when reintroducing, regrading back onto enteral feeds and the monitoring of blood sugars?

Many thanks

Stay Safe

Alistair

[bimalc]

On 11/7/2020 at 3:06 PM, ali said:

Hello 99Nicu,

Recently we have had a number of infants who have required IV Dextrose infusions following episodes of low sugars. Does anyone know of or use a specific guideline when reintroducing, regrading back onto enteral feeds and the monitoring of blood sugars?

Many thanks

Stay Safe

Alistair

Can you provide more context on the patient population/circumstances you are interested in?  I doubt there are general guidelines given the wide array of underlying etiologies which might lead to hypoglycemia.  In general, my approach includes assessment of the reason for the original hypoglycemia, current degree of enteral tolerance/expected tolerance, present glucose levels, risk of critical hypoglycemia with weaning of GIR.  At a high-level, though, I view the IV glucose as ensuring metabolic stability while enteral nutrition established.  Depending on the urgency of coming off IVF we will wean GIR for pre-prandial blood sugars >60-70mg/dL.

[Stefan Johansson]

We don't have a written guideline but I tell you how we do

First of all, we give enteral feeding 3h with the iv-dextrose. Depending on the total volume/24h, the enteral volume depends but usually (if the infant maintains S-Na etc), we are fairly liberal and allow higher total volumes than we would normally do (like 100+ ml/kg/d the first day of life)

When the infant is normoglycemic, we have a standard way of decreasing the iv-infusion, we typically reduce the glucose infusion (most often we can use 10%) with 1 ml/hour at every 3h meal. Usually we plan enteral feeding volumes for the coming 24 hours, but in these cases we may adjust feeding volumes every 12 hours.

So, we start off with iv glucose and enteral nutrition, and gradually shifts over to full enteral nutrition. We keep checking blood sugars a ~2-3 times after we have stopped the infusion.