Normoglycemia (10Ns)

This page is part of the 10N-Matrix for a high quality conduct of pediatric anesthesia care.

← previous (Normonatremia) | next (Normothermia) →

Definition

Normal blood glucose concentration within the age specific normal range.

Importance

Blood glucose homeostasis is important for ensuring a continuing energy supply and stable plasma osmolality. Small infants have reduced glycogen storage capacity and hence have a limited ability to maintain blood glucose concentrations during periods of fasting.

Consequences

Acute and chronic changes in blood glucose concentrations have significant consequences to the perioperative outcome.

Hypoglycemia

irritability
seizures
hemodynamic instability
coma, death

Hyperglycemia

hyperosmolality
ketoacidosis
polyuria and dehydration and
seizures, death

Prevention and treatment

awareness of fasting and nutrition status of the patient, minimize preoperative fasting times
perioperative (surgical) stress reduction (analgesia and body temperature control)
situation appropriate monitoring (neonates, critically ill children) and investigations
consider isotonic glucose containing perioperative intravenous solutions especially in preterm, neonates and small infants, patient on total parental nutrition (TPN) and critically ill patients
patients with inherited and acquired endocrine or glucose dependent metabolic disorders require special attention and workup
prompt and appropriate treatment of significant hypo- and hyperglycemia

Key references

Sümpelmann R, Becke K, Brenner S, Breschan C, Eich C, Höhne C, Jöhr M, Kretz FJ, Marx G, Pape L, Schreiber M, Strauss J, Weiss M. Perioperative intravenous fluid therapy in children: guidelines from the Association of the Scientific Medical Societies in Germany. Paediatr Anaesth. 2017 Jan;27(1):10-18.