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Hypoglycemia and Hyperglycemia
Case Synopsis
An otherwise healthy 4-year-old boy is scheduled for inguinal hernia repair. He has dinner at 5 pm the evening before surgery, as well as milk and cookies before going to bed at 9 pm . He is offered apple juice at 5:30 am (2 hours before his scheduled surgery), which he refuses. Owing to a surgical emergency, the boy’s surgery is delayed 4 hours. Before induction of anesthesia, his vital signs are stable, but he is drowsy and somewhat fussy. His serum glucose concentration in the operating room after induction of anesthesia is 64 mg/dL.
Acknowledgment
The author wishes to thank Dr. D. Ryan Cook for his contribution to the previous edition of this chapter.
Problem Analysis
Definition
Clinical hypoglycemia can be defined as a plasma glucose concentration that is low enough to manifest as signs or symptoms of impaired brain function. Although hypoglycemia is often defined as a blood glucose concentration less than 55 mg/dL (3 mmol/L) in infants and older children and 35 mg/dL (2 mmol/L) in premature and term neonates, these values have been derived statistically and cannot necessarily be applied to individual patients without regard to clinical findings. ( Note: To convert mmol/L to mg/dL, simply multiply by 18.)
Hyperglycemia is usually defined as a blood glucose concentration greater than 200 mg/dL (11 mmol/L).
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