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Treatment of asymptomatic and symptomatic Hypoglycemia

The treatment of asymptomatic hypoglycemia is by enteral feeding rather than intravenous glucose however if symptoms persist despite enteral feeding intravenous glucose in indicated

In case of symptomatic hypoglycemia intravenous administration of 2 ML per kg of 10% dextrose water is indicated and if hypoglycemic seizures are present then the dose is 4 ml per kg of 10% dextrose water

For the management of Persistent neonatal or infantile hyperglycemia at first the rate of intravenous glucose infusion is increased to 10 to 15 milligram per kg per minute or more if needed
Furthermore Central venous Line or umbilical venous catheter may be inserted to administer 25% dextrose water

If hyperinsulinemia is present it should first be medically managed using diazoxide and then somatostatin analogues

If it is unresponsive to medical management then surgery in the form of focal or total pancreatectomy is indicated

The dose for oral diazoxide is 5 to 15 milligram per kg per 24 hour in to divided doses.  it can reverse the symptoms of hyperinsulinemic hypoglycemia  however it can produce edema nausea hirsutism hyperuricemia electrolyte disturbances immunoglobulin G deficiency advanced bone age.

Glucagon can be given by continuous IV infusion at 5 microgram per kg per hour together with somatostatin administered subcutaneously every 6 to 12 hourly in the dose of 20 to 50 microgram per kg per day

The unusual complications of octreotide includes poor growth because of inhibition of growth hormone release ,pain at injection site, vomiting ,diarrhoea and hepatic dysfunction in the form of Hepatitis and cholelithiasis , or necrotising enterocolitis or tachyphylaxis may also occie.

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