University of Colorado School of Medicine Denver, Colorado Supported in part by NIH-NICHD Program Grant HD 00781. Dr. Hay is the recipient of Special Emphasis Research Career Award (AM00879, Diabetes Mellitus: Pediatric Aspects), NIH-NIADDK/NICHD. Correspondence: William W. Hay, Jr., University of Colorado Health Sciences Center, 4200 E. 9th Avenue, Container B-195, Denver, CO 80262.
The effect of fasting during pregnancy is of particular interest in the guinea pig because of the large fetal mass carried to term. The present studies examined the effect of acute and chronic starvation on maternal glucose turnover in the guinea pig. In the first experiment, 7 near-term pregnant guinea pigs were fasted for 6 h. The maternal glucose concentration and glucose production decreased rapidly, falling to about 65–70% of fed levels at 4 h of starvation. Mothers demonstrated a 2.6-fold elevation in ketoacids after 2, 4 and 6 h of starvation. In a second experiment, 5 non-pregnant and 11 near-term pregnant animals were studied in the control period and after 24 h of fasting. The maternal glucose concentration in the control state was independent of fetal mass. The maternal glucose turnover rate in the fed state correlated linearly with fetal mass. After 24 h of fasting, the glucose concentration and glucose turnover rate both decreased, with the magnitude of each decrease proportional to fetal mass. We conclude that, in the pregnant guinea pig, the fetal mass impacts significantly on maternal glucose metabolism in the fed and fasting states.
To the Editor.
In the HSIM, LOS was consistently presented as “goal LOS,” rather than “average LOS” or “maximum permissible LOS.” The goal LOSs were intended as “ambitious,” and to be applicable only to uncomplicated patients. Many contributors used the notion of goal LOS as analogous in part to the game of golf. If one considers pediatricians to be like golf pros providing professional services to the broad range of golfers, it should not be surprising that many or most receiving professional services (patients) do not achieve par. Less than 5% of the golfing population regularly shoots par on a given hole (G. Norman, personal communications, May 2000). However, I would submit that our problem in pediatrics is not with those who set par at a particular number of strokes for a golf hole or golf course, but rather with those who would set the greens fees (or reimbursement) too low, would ask the golfers to leave the course after 72 strokes, and would hold the golf pros responsible for the diversity in the performance of the golfing population and their routine failure to achieve par. Those actions would be unacceptable in golf, and by analogy, I would suggest that the pediatric community should offer strong and informed resistance to both episodic and systematic misapplications of the “goal of LOS” to their patients.
Pediatric HSIM was developed as a compendium of best practices within the continuum of care for pediatric patients, and was not intended to provide the detailed medical information necessary for diagnosis or for direct patient care. HSIM was not intended as guidelines in the sense of the Institute of Medicine or the Agency for Health Care Policy and Research usage of the term. While generally referred to in the article as “guidelines”, HSIM itself uses the word …
