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Wilms' Tumor and Hypoglycemia

Answer: D. 

The presentation of a young child with insidious abdominal pain, flank mass, and hematuria is indicative of a Wilms’ tumor.  A large tumor burden such as in Wilms or neuroblastoma may cause hypoglycemia, due to increased demand.  The causes of hypoglycemia in children are many; a selected list includes:



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One ampule of D50 contains 25 g of glucose, and is suitable for adult administration.  Smaller veins tolerate lower osmotic loads.  The typical neonatal acute dosing of glucose is 5-10 mL/kg of D10.  The acute dose for a child is 2-4 mL/kg D25.   Children with profound hypoglycemia will then need maintenance dosing and frequent monitoring.

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