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Hypoglycemia
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OCT 08, 2015
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I. Foals at Risk
Peracute or cardiac form
- Cesarean section or dystocia with anesthesia.
- Premature or small for gestational age.
- Neonatal Isoerythrolysis foals.
- Hypothermia.
- Asphyxia and hypoxia.
- Septicemia.
- Maladjustment syndrome.
- Inherited metabolic defects
- Lysosomal storage disease
- Glycogen Branching Enzyme deficiency (See Congenital Anomalies and Genetic Disorders)
- Previous bolus injections of glucose or rapid rate of glucose infusion and sudden cessation.
- "Rebound" hypoglycemia following bolus.
- When parenteral nutrition discontinued.
- Orphan foals.
- Liver failure - Tyzzer's disease.
- Hyperlipidemia.
II. Symptoms
- Many foals merely look weak, or are floppy and falling when attempting to rise. It may manifest as decreased nursing, apathy or lethargic appearance.
- Seizures are not a consistent clinical sign even with prolonged hypoglycemia.
III. Diagnosis
- Asymptomatic hypoglycemia.
- Suspect when dextrose stick is less than 60 mg/dl (3.3 mmol/l).
- Order Stat quantitative blood glucose.
- Diagnosis is glucose less than 40 mg/dl (2.2 mmol/l) in a presuckle foal and less than 80 mg/dl (4.4 mmol/l) in a foal >2 hours which has suckled.
- Symptomatic hypoglycemia is defined as symptoms that disappear with glucose infusion regardless of blood glucose level.
IV. Therapy
- Draw pretreatment blood for quantitative glucose.
- Symptomatic foal: foal that has not nursed with no measurement - 8 mg/kg/min glucose (high end of the dose range) which translates to 200 ml/h of 10% dextrose in an isotonic crystalloid like LRS or Plasmalyte 148A for an average sized foal (which is a dose rate of 4 ml/kg/h of a 10 % dextrose solution) for the first hour, then decrease to 4 mg/kg/min after that (200 ml/h of 5% dextrose). Recheck glucose in 1 hour. (See section on Fluid therapy).
- Attempt to maintain blood sugar at 100-160 (80-180) mg/dl (4.4-10 mmol/l). Check serum Na to avoid hyponatremia.
- Begin oral feedings of milk or 10% dextrose or karo (corn) syrup in a syringe or by nasogastric tube.
- Correct predisposing causes and provide nursing care.
- Monitor glucose every 4 to 6 hours via dextrose sticks.
- Correct any concurrent acid base imbalance or hypoxemia.
V. Prognosis is Poor to Guarded, Treatment Must Be Started Early to Be Beneficial
- Prolonged hypoglycemia can result in permanent neurologic defects.
- We have found a reasonable response to severe (10-15 mg/dl [0.6-0.8 mmol/l] blood glucose) hypoglycemias if correction of the concurrent initiating factors can be accomplished.
- A recent multicenter study evaluated the association between blood glucose and survival rates of critically ill neonatal foals. 29.1% of the study population had blood glucose concentrations within the reference range of 4-7 mmol/l (76-131 mg/dL) at admission, 36.5% were hyperglycemic, and 34.4% were hypoglycaemic. Foals with blood glucose concentrations <2.8 mmol/L (50 mg/dL) or >10 mmol/L (180 mg/dL) at admission were less likely to survive [1].
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How to reference this publication (Harvard system)?
Madigan, J. E. (2015) “Hypoglycemia”, Manual of Equine Neonatal Medicine. Available at: https://www.ivis.org/library/manual-of-equine-neonatal-medicine/hypoglycemia (Accessed: 10 June 2023).
Affiliation of the authors at the time of publication
School of Veterinary Medicine, University of California-Davis, CA, USA.
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