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essay writing self help is the best help The rise in blood glucose may last 2 to 3 hours and is cost viagra cialis levitra useful until parenteral glucose can be started. This method is rarely used. The hypoglycemia of most idms usually responds to the treatment mentioned earlier and resolves by 24 hours. Persistent hypoglyt:Emia is usually due to a continued hyperinsulinemic state and may be manifested by the requirement for glucose use of> 8 mg of glucose/kg/min (fig. 24.1). Efforts should be made to decrease islet cell stimulation (e.G., keeping blood glucose adequate but not high, moving a high umbilical artery line to a low line). If the hypoglycemia lasts >7 days, consider other etiologies (see chap. 24). Vii. Respiratory distress in infants of diabetic mothers (idms) a. General principles 1. Epidemiology. With changes in pregnancy management resulting in longer gestations and more vaginal deliveries, the incidence ofrds in idms has fallen from 28% during 1950 to 1960 to 4% in 1990, with the major difference in the incidence of rds between diabetics and nondiabetics occurring in infants born before 37 weeks' gestation. Most of the deaths from rds also occur at <35 weeks' gestation in infants who were delivered by cesarean section because of fetal distress or maternal indications. 2. Etiology. Besides rds, causes of respiratory distress are cardiac or pulmonary anomalies (4%), hypertrophic cardiomyopathy, transient tachypnea of the newborn, and polycythemia. Pneumonia, pneumothorax, and diaphragmatic hernia should also be considered. Delayed lung maturity may occur in idms because hyperinsulinemia blocks cortisol induction oflung maturation. B. Diagnosis 1. Laboratory studies (see chap. 33 for the differential diagnosis and management of respiratory disorders.) a. Blood gas analysis should be performed to evaluate gas exchange and the presence of right-to-left shunts. 20 i diabetes mellitus b. Blood cultures, with spinal-ftuid examination and culture, should be taken if the infant's condition permits and infection is a possibility.

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