A term large-for-gestational age newborn infant was born 50 hours ago by cesarean section to a 26-year-old primigravida mother with insulin-dependent gestational diabetes. The infant’s initial glucose was 25 mg/dL, but after feeding subsequent glucoses have all been above 60 mg/dL. The infant is now diaphoretic and irritable, and seems to have some twitching and tremors of the extremities. The most likely cause of this infant’s problems is which of the following?
Correct Answer: Hypocalcemia
Description: Congenital heart disease, neural tube defects, small left colon, and metabolic derangements are all more common in infants of diabetic mothers. Hypoglycemia in these infants is usually seen in the first 24 hours of life. In utero exposure to the mother's hyperglycemia leads to fetal islet cell hypertrophy and beta cell hyperplasia, resulting in increased insulin production. After the umbilical cord is severed, that glucose supply is abruptly terminated and the elevated insulin levels cause hypoglycemia.Between 48 and 96 hours of life, these infants have usually achieved glycemic control. However, many now develop hypocalcemia and hypomagnesemia. Hypocalcemia is thought to result from delayed parathormone (PTH) synthesis and/or responsiveness in the infant of a diabetic mother. Symptoms of hypocalcemia may include irritability, sweating, tremors, twitches, seizures, and arrhythmias. In the vignette, the child was showing symptoms of hypocalcemia in the appropriate time frame after delivery. Treatment of symptomatic infants is intravenous calcium gluconate.
Category:
Pediatrics
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