A 3-week-old neonate presents with jitteriness, poor feeding, and blood glucose of 32 mg/dL. Weight is 3.5 kg. What is the appropriate initial management?
- A IV bolus of 10% dextrose 2 mL/kg over 1 minute ✓
- B Oral 15% dextrose gel 200 mg/kg buccally
- C IV bolus of 25% dextrose 2 mL/kg over 1 minute
- D Subcutaneous glucagon 0.03 mg/kg
Correct answer: A. IV bolus of 10% dextrose 2 mL/kg over 1 minute
Explanation
Symptomatic neonatal hypoglycemia requires immediate IV 10% dextrose at 2 mL/kg (D10W 2-3 mL/kg). D25W is hypertonic and risks intracranial hemorrhage if extravasation occurs, hence avoided in neonates. Dextrose gel is for asymptomatic screening in at-risk newborns, not symptomatic treatment. Glucagon is ineffective in neonates due to limited glycogen stores.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.