When do I start to panic?

[ERDoc]

Here is a clip from Micromedix. If your pt is hypoglycemic and having a seizure, I think we could all agree that the benefits outweight the risks. I also can't imagine a one time dose would be a problem. Chronic hyperglycemia during pregnancy can be a bad thing though. If mom can tolerate PO, give her PO.

REPROTOX®

GLUCOSE

Quick take: Abnormally high blood glucose may cause abnormal embryo development in diabetic pregnancies.

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Glucose (dextrose) is a hexose found as an energy source in many biologic systems. Concern about the effects of glucose on embryonic development are based on the finding that infants of diabetic women have an increased incidence of congenital anomalies (see below). Experiments with early (2 and 8 cell) hamster embryos in vitro have shown that the presence of small amounts of glucose in the medium inhibits development (1,2). Culture of rat embryos with glucose concentrations many times those achieved even in diabetic women results in the production of anomalies, particularly involving the central nervous system (3-5). Animal experiments using l-glucose, the nonmetabolizable isomer of naturally occurring d-glucose, suggest that osmotic effects may play a role in producing some of the defects associated with elevated serum glucose (16).

Pregnancies in diabetic women carry an increased rate of congenital anomalies, with estimates ranging from 6 to 13% (6-8). The most common abnormalities are cardiac and neural tube defects. With more strict metabolic control of diabetes using insulin (#1095) and close monitoring of glucose or glycosylated macromolecules, the congenital anomaly rate appears to be decreased, provided such control is instituted very early in the pregnancy (9-11). These findings suggest but do not prove that an elevated glucose level in maternal blood is the teratogenic principle in diabetic pregnancies. Mothers who develop gestational diabetes in mid or late pregnancy also have an increased risk of pregnancy complications. Tight glucose control in these patients can also improve perinatal outcome (15).

Intravenous solutions containing glucose may be administered during labor; however, if the rate of administration is too rapid, maternal hyperglycemia may lead to reactive neonatal hypoglycemia. Other metabolic abnormalities described in neonates after maternal intravenous glucose during labor include hyponatremia and metabolic acidosis (12,13). However, another study did not find acidosis to be a problem after use of large amounts of intravenous glucose during labor (14).

Selected References

1. Seshagiri PB, Bavister BD: Glucose inhibits development of hamster 8-cell embryos in vitro. Biol Reprod 40:599-606, 1989.

2. Schini SA, Bavister BD: Two-cell block to development of cultured hamster embryos is caused by phosphate and glucose. Biol Reprod 39:1183-92, 1988.

3. Garnham EA et al: Effects of glucose on rat embryos in culture. Diabetologia 25:291-5, 1983.

4. Cockroft DL, Coppola PT: Teratogenic effects of excess glucose on head-fold rat embryos in culture. Teratology 16:141-6, 1977.

5. Sadler TW: Effects of maternal diabetes on early rat embryo-genesis. 2. Hyperglycemia-induced exencephaly. Teratology 21:349-56, 1980.

6. Molsted-Pederson L et al: Congenital malformations in newborn infants of diabetic women. Lancet 1:1124-6, 1964.

7. Soler NG et al: Congenital malformations in infants of diabetic mothers. QJ Med 178:303-13, 1976.

8. Mills JL: Malformations in infants of diabetic mothers. Teratology 25:385-94, 1982.

9. Fuhrmann K et al: The effect of intensified conventional insulin therapy before and during pregnancy on the malformation rate in offspring of diabetic mothers. Exp Clin Endocrinol 83:173-7, 1984.

10. Molsted-Pederson L, Pederson JF: Congenital malformations in diabetic pregnancies. Acta Paediatr Scand 320(Suppl):79-84, 1985.

11. Damm P, Molsted-Pederson L: Significant decrease in congenital malformations in newborn infants of an unselected population of diabetic women. Am J Obstet Gynecol 161:1163-7, 1989.

12. Philipson EH et al: Effects of maternal glucose infusion on fetal acid-base status in human pregnancy. Am J Obstet Gynecol 157:866-73, 1987.

13. Singhi S et al: Iatrogenic neonatal and maternal hyponatraemia following oxytocin and aqueous glucose infusion during labour. Br J Obstet Gynaecol 91:1014-8, 1984.

14. Piquard F et al: Does fetal acidosis develop with maternal glucose infusion during normal labor? Obstet Gynecol 74:909-14, 1989.

15. Thompson DM, Dansereau J, Creed M, Ridell L: Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes. Obstet Gynecol 83:362- 6, 1994.

16. Gale TF: Effects of in vivo exposure of pregnant hamsters to glucose. 1. Abnormalities in LVG strain fetuses following intermittent multiple treatments with two isomers. Teratology 1991;44:193-202.

© 1974-2008 Thomson Healthcare. All rights reserved.

[Coyote Medic]

So is the code a result of eclampsia? And if so, what would have been the right treatment before the seizure? Load and go? What about an IV in the jugular vein? I agree with the post about most of us not learning the OB stuff. It seems it always comes at the end of the class and gets brushed over due to time constraints. That sucks because being a male, with no prior hx with pregnancy, I have no clue what is going on in this woman's body. Last question, was the BGL in the 35-40 range? If so, I think I would tried real hard to get that IV and give her some glucose.

[DwayneEMTP]

However, another study did not find acidosis to be a problem after use of large amounts of intravenous glucose during labor.

Thanks for that Doc...I didn't see what they considered "large amounts", any ideas what range they might be refering to?

Dwayne

[ERDoc]

Thanks for that Doc...I didn't see what they considered "large amounts", any ideas what range they might be refering to?

Dwayne

No, but I'm sure if you were interested you could look through the articles cited in the info. Coyote, the correct treatment depends on what caused the seizure. I'll be honest, I haven't read this case over in a while so I don't remember what the final answer was, but if she was hypoglycemic she needs glucose and if she was eclamptic she needs magnesium.