With 50 pediatric surgical patients including 7 neonates undergoing intravenous hyperalimentation (IVH) after operation, effects of surgical stresses on glucose metabolism were studied from pre- to immediate post-operative periods. Parameters used were blood sugar (BS), immunoreactive insulin (IRI) and immunoreactive glucagon (IRG) in addition to preoperative intravenous glucose tolerance test (IVGTT) with caluculation of glucose disappearance rate (K-value). In neonates, IRI levels were decreased preoperatively and they maintained the decreased level, even in the postoperative period when the blood sugar level was elevated. IRG levels did not differ from those observed in the adults. However, in cases with severe inflammation in particular, the levels were increased remarkably from pre-to postoperative periods. In infants, secretion of insulin was clearly seen and the level of it showed a pararell move with blood sugar level. IRG levels showed no remarkable changes. However, in patients with congenital bile duct atresia, hyperglucagonemia was observed. In children both IRI and IRG showed similar changes as observed in infants. However, in patients with portal hypertension, hyperglucagonemia was observed. All patients for whom K-values were obtained showed the normal level, irrespective of the ages. But, in neonates, insulin secretion in response to the glucose load was considerable diminished at 5min. after the commencement of the test. These results appear to suggest that, in neonates, comsumption of glucose is not diminished, but the secretion of insulin in response to the glucose load is decreased, indicating no immediate accomodation to a large amount of glucose load. Thus, in prescribing IVH on neonates, it seems important to realize that accommodation to a new concentration of IVH solution takes a rather long time. It is advisable to start with 10% solution and an incremental dose of 3% or less to a maintenance dose of less than 18%.
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