BCHS-4361-09-NEONATA_38681

BCHS-4361-09-NEONATA - I NEONATAL HYPOGLYCEMIA AND THE IMPORTANCE OF GLUCONEOGENESIS Infants born to diabetic mothers who have had inadequate

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I. NEONATAL HYPOGLYCEMIA AND THE IMPORTANCE OF GLUCONEOGENESIS Infants born to diabetic mothers who have had inadequate maternal glucose control during pregnancy (I.e. gestational diabetes) face potentially serious metabolic difficulties. Typical characteristics: - Excessive size at birth, including length, weight and head circumference - large organs -chronic oxygen deficit, which becomes more severe as pregnancy proceeds -hypoglycemia beginning soon after birth -seizures and brain damage can result
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II. NEONATAL HYPOGLYCEMIA AND THE IMPORTANCE OF GLUCONEOGENESIS How can onset of hypoglycemia be explained? In fetal metabolism, there is a need for continual supply of substrates across maternal and placental circulation. This need ceases at birth. Primary metabolic substrates for fetus are glucose, lactate, amino acids, free fatty acids and other essential lipids. Most important purpose of glucose is for brain oxidative metabolism. Overall fetal requirement for glucose consumption near term is 0.04 mmol/kg/minute.
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III. NEONATAL HYPOGLYCEMIA AND THE IMPORTANCE OF GLUCONEOGENESIS What ensures fetus receives a constant supply of glucose? Glucose transport from maternal to fetal circulation occurs by facilitated diffusion across placental membrane. While this system will equilibrate glucose concentration across membranes, sugar cannot move against a concentration gradient. Therefore, amount of glucose received by fetus depends on maternal glucose concentration. If latter is high, more glucose will be delivered to fetus.
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IMPORTANCE OF GLUCONEOGENESIS In addition to glucose, fetal endocrine environment is important; Prior to birth, it promotes anabolic processes. Insulin is released from the fetal pancreas in response to rise in blood glucose. Glucose is taken up into skeletal muscle and fat cells, where it is largely converted to glycogen and triacylglycerols, respectively. Protein synthesis occurs Glycogenolysis, proteolysis, gluconeogenesis and lipolysis are inhibited. Counter-regulatory hormones, I.e. glucagon and epinephrine,
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This note was uploaded on 01/23/2011 for the course BCHS 4361 taught by Professor Echberg during the Spring '09 term at University of Houston.

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BCHS-4361-09-NEONATA - I NEONATAL HYPOGLYCEMIA AND THE IMPORTANCE OF GLUCONEOGENESIS Infants born to diabetic mothers who have had inadequate

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