Neonatal Hyperglycemia Following Maternal Diazoxide Administration

Abstract

A 31-year-old woman, gravida 1, para 0, noted to have proteinuria (2+) and blood pressure (BP) of 130/90 mm Hg at approximately 30 weeks' gestation, was hospitalized at 33 weeks with complaints of abdominal pain. A BP of 200/130 mm Hg, with 3+ reflexes, ankle edema, and proteinuria (3+) were present. Mild uterine contractions ensued, with BP to 240/140 mm Hg. The mother was initially treated with intramuscular magnesium sulfate and hydralazine hydrochloride, with reduction in BP to 194/130 mm Hg.Approximately 2 1/2 hours before delivery, furosemide, 40 mg, and diazoxide, 300 mg, were given IV and repeated with a dosage of furosemide, 40 mg, and diazoxide, 200 mg, 20 minutes later. Maternal BP dropped to 128/80 mm Hg. Due to variable decelerations in fetal heart rate, a cesarean section was performed. The mother was delivered of a 1,500-g girl, with Apgar scores of 6 at one minute and 8 at five minutes. Physical examination disclosed a 32-week-old tachypneic infant with mild intercostal and substernal retractions and nasal flaring. Course rhonchi were noted; good tone and an intact Moro's reflex were present. Initial determinations of blood gas levels showed a pH of 7.24; Pa02, 40 mm Hg; and Paco2, 57 mm Hg. The BP was 44/15 mm Hg; heart rate, 158 beats per minute; and respirations, 98/min. An umbilical arterial catheter was placed, and an IV solution of dextrose, 10% at 5 mL/hr, was started. The infant was placed in 34% oxygen and was transported to this hospital.On admission at 7 hours of life, rectal temperature was 36.2°C; respirations, 45/min; and heart rate, 140 beats per minute. The infant experienced increased respiratory difficulty and underwent intu¬ bation. Laboratory studies disclosed a sodium level of 128 mEq/L; potassium, 6.2 mEq/L; chloride, 88 mEq/L; carbon diox¬ ide content, 22 mM; calcium, 7.1 mg/dL; total bilirubin, 4.5 mg/dL; hematocrit, 51 g/dL; and blood glucose, 522 mg/dL. Urinalysis showed 2+ glucose; no ketones; specific gravity, 1.013; and pH, 5.0. The 10% dextrose IV solution was immediately switched to 0.45% normal saline without dextrose, which the infant received for the first six days of life. Oral feedings of a commercial lactose-containing formula providing 0.67 cal/mL began on the second day of life at 20 cal/kg of body weight. The Figure depicts the infant's blood glucose concentrations during the first five days of life. The infant received one dose of 0.1 units/kg of IV insulin at 40 and 48 hours of life.The infant responded to these two doses and required no further insulin. The fasting plasma insulin level obtained on the fourth day of life was 6 uU/mL, with a blood glucose level of 91 mg/dL. Blood glucose concentrations returned to normal by the fifth day of life and remained with¬ in normal limits with oral feedings of the commercial formula at 80 cal/kg of body weight. Repeated plasma insulin levels obtained on the 98th and 119th day of life were 6 uU/mL, with a blood glucose level of 85 mg/dL, and 7 uU/mL, with a blood glucose level of 95 mg/dL, respectively. During her h...