IV dextrose and neonatal hypoglycemia

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mianderson - 24 Sep 2005 20:36 GMT

For an infant whose blood glucose levels are really low, why give IV
dextrose as opposed to another sugar?

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David Rind - 24 Sep 2005 21:32 GMT

> For an infant whose blood glucose levels are really low, why give IV
> dextrose as opposed to another sugar?

I suspect the answer to your question is that "dextrose" is just another
term for "glucose".

If your question is really "how do we know that IV glucose is better for
a low glucose level in neonates than some other sugar?", I don't know
the answer or that it has ever been studied. It may just be that it
seems to work and people figured it was obvious. (That doesn't mean
they're right.)

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David Rind
drind@caregroup.harvard.edu

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mianderson - 26 Sep 2005 22:58 GMT

> > For an infant whose blood glucose levels are really low, why give IV
> > dextrose as opposed to another sugar?
>
> I suspect the answer to your question is that "dextrose" is just another
> term for "glucose".

ummm...i kinda know that. The question was why glucose/dextrose as
opposed to sucrose, maltose, fructose, etc.....

> If your question is really "how do we know that IV glucose is better for
> a low glucose level in neonates than some other sugar?", I don't know
> the answer or that it has ever been studied.

it's been studied a lot.and Im sure it has something to do with a
problem neonates have in sugar metabolism dealing with the bbb or
something similar......right now I just don't have the answer.

It may just be that it

> seems to work and people figured it was obvious. (That doesn't mean
> they're right.)

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Sbharris[atsign]ix.netcom.com - 26 Sep 2005 23:06 GMT

> > > For an infant whose blood glucose levels are really low, why give IV
> > > dextrose as opposed to another sugar?
[quoted text clipped - 4 lines]
> ummm...i kinda know that. The question was why glucose/dextrose as
> opposed to sucrose, maltose, fructose, etc.....

COMMENT:

You couldn't give sucrose IV-- like lactose this disacharide needs an
enzyme at the intestinal border to break down, so if you bypassed that
IV, you'd get a compound in the blood what couldn't be used. That might
be, and probably is, also true even of maltose-- not sure. As I
understand it, liver glycogen gets released into blood only as glucose,
so I wouldn't give nickel on bet that any other cell in the body has
any way to use a disacharide directly.

In theory, IV fructose could be given, as it's converted by the liver
to glucose. But since glucose is the major blood sugar and the one that
is used directly by the brain, and universally the one given IV,
there's no reason to develop an IV fructose preparation. High blood
fructose levels also screw up triglyceride levels and do other bad
things, so that would be a double reason not to give it to neonates IV.

SBH

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David Rind - 26 Sep 2005 23:34 GMT

>>>For an infant whose blood glucose levels are really low, why give IV
>>>dextrose as opposed to another sugar?
[quoted text clipped - 4 lines]
> ummm...i kinda know that. The question was why glucose/dextrose as
> opposed to sucrose, maltose, fructose, etc.....

Hard to tell exactly what level of people have and what they are asking
over the Net. Hard to imagine anyone giving an infusion of sucrose, though.

>>If your question is really "how do we know that IV glucose is better for
>>a low glucose level in neonates than some other sugar?", I don't know
[quoted text clipped - 3 lines]
> problem neonates have in sugar metabolism dealing with the bbb or
> something similar......right now I just don't have the answer.

Okay, if you say so. I can't find any studies comparing different sugar
infusions in neonates. Perhaps you could point me to one?

Glucose has the advantage (whether in neonates or adults) that it is
usable by the brain. Ketone bodies can also be used. I have no knowledge
about any other sugars. As far as I know everyone just infuses the sugar
that the body produces naturally.

Is this some sort of test question you encountered in school? I'm trying
to picture why an answer of "Well, the glucose level is low, so we're
infusing glucose" doesn't seem adequate in the absence of studies
showing that some other infused sugar works better.

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David Rind
drind@caregroup.harvard.edu

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Bob - 27 Sep 2005 02:57 GMT

>> ummm...i kinda know that. The question was why glucose/dextrose as
>> opposed to sucrose, maltose, fructose, etc.....

Two of those are disaccharides. Are they cleaved in the bloodstream
(or only in the GI)???

I would also presume that all those are more expensive than glucose.

>Is this some sort of test question you encountered in school? I'm trying
>to picture why an answer of "Well, the glucose level is low, so we're
>infusing glucose" doesn't seem adequate in the absence of studies
>showing that some other infused sugar works better.

Perhaps the OP can explain why one might want to use some other sugar
than the obvious one.

bob

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