Use of supplementary infusions to optimise glucose delivery rates

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For newborn babies on intravenously administered nutrition, particularly if premature, it is important to provide an appropriate amount of energy to prevent catabolism without also inducing hyperglycaemia or hyperlipidaemia. In the early days of life, intravenous energy is often administered as simple glucose infusions, with the possibility of also providing energy as lipids if parenteral nutrition is involved. When considering the rate of administration of parenteral glucose, it is usual to pay attention to the glucose delivery rate (GDR, also known as the glucose infusion rate; GIR) in addition to blood glucose levels. For most patients a GDR of 4–8 mg/kg/minute is sufficient (Mesotten et al, 2018), but some patients may require higher rates if their energy use or insulin levels are greater than usual.

The following case considers a 2.5 kg neonate with hyperinsulinism is receiving 6.5 ml/hour of 20% (20 g/100 ml) glucose to maintain blood glucose in the intended range (>4 mM). Give all answers to 1 decimal place.