what is GIR in TPN

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I'm trying to understand what is the GIR is, i had a hypoglycaemic baby today, his RBS was only 32 and he was on D5, then after giving the 2cc push of D10, the doctor changed the dextrose in the TPN to D6.2% and after one hour the RBS was 38! i asked the doctor if we can just hang a D7.5 or even a D10. he said : but the GIR is already 11! its more than adequate!

i don't understand what the GIR is and why the doctor is so obsessed with it and refused to change the dextrose to a higher concentration! we kept pushing 2cc of D10 every hour for 3 times until my shift ended and the baby still hypoglycaemic !

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Specializes in NICU, Infection Control.

I googled "gir" and got "glucose infusion rate", among other [nonapplicable] definitions. I googled that and found this tool: Glucose Flow Calculator as well as these other things on google: https://www.google.com/#bav=on.2,or.r_cp.r_qf.&fp=eb006a79961ee624&q=Glucose+Infusion+Rate .

Hopefully, you can figure out what you need to know from that info.

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Specializes in NICU, Infection Control.
Parenteral Nutrition Tutorial | Nutrition | Infusion Rate of Dextrose This is a short item which may answer your question; don't want to copy and plagarize it.
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Specializes in NICU, PICU, PACU.

It shouldn't really matter, you have increase the concentration to get the blood sugar up, not keep bolusing.

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Specializes in NICU, PICU, PACU.

Sorry list my Internet connection last night! If the kid is a bad IDM, like the mom is on an insulin drip, some kids need a huge GIR, if it still doesn't come up them they need to investigate for endocrine problems. We had one kid we had on D25 thru a UVC to keep his glucose above 30....then the kid shot up to over 900... And stayed there, turned out he had some bizarre inborn metabolism error...he ended up dying as he went into multi-organ failure...it was awful :( we had him on a huge insulin load and it just wouldn't budge.

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Specializes in L&D, OBED, NICU, Lactation.
I'm trying to understand what is the GIR is, i had a hypoglycaemic baby today, his RBS was only 32 and he was on D5, then after giving the 2cc push of D10, the doctor changed the dextrose in the TPN to D6.2% and after one hour the RBS was 38! i asked the doctor if we can just hang a D7.5 or even a D10. he said : but the GIR is already 11! its more than adequate!

i don't understand what the GIR is and why the doctor is so obsessed with it and refused to change the dextrose to a higher concentration! we kept pushing 2cc of D10 every hour for 3 times until my shift ended and the baby still hypoglycaemic !

This math doesn't make sense. In order to get a GIR of 11 with D6.2, you need to be giving almost 250ml/kg of fluid. Were there other things running as well with higher Dex?

Quick calculations for Glucose infusion rate = (ml per hour * dextrose concentration) / (6 * body weight in kg) or (dextrose concentration * ml/kg/day) / 144 note, you will get SLIGHTLY different numbers, but they are usually close. Most people use the first formula.

Example 2.5kg baby on 80ml/kg/day of D10W = GIR of 5.5. (8.3ml/hr * 10% dextrose)/ (6 * 2.5) = ~5.5 mg/kg/min glucose delivery

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thats why i asked about it, i felt something was wrong in that TPN.

that baby had no other drips going on.

our doctors usually fill a TPN request paper in the morning, they specify the GIR they want and the total intake. they don't tell how much the dextrose concentration. we send the request to the pharmacy and they calculate the dextrose concentration based on the GIR the doctore ordered. and that what i want to understand.

because he couldn't believe a baby with a GIR 11 and he is still hypoglycaemic.

and i couldn't believe a dextrose concentration of 6% would help at all.

maybe it was a mistake in the TPN preparation from the pharmacy or something.

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Specializes in Neonatal ICU (Cardiothoracic).

This is very odd...there's no way you could be delivering a GIR of 11 unless your baby weighed like, 100 grams...haha. The glucose infusion rate is a calculation of the infusion of mg/kg/min of glucose entering the baby. Ideally term neonates need a GIR of 4-6 and preemies 6-8mg/kg/min unless they're sick or there's gestational diabetes or neonatal diabetes afoot. Apple has a great free GIR calculator called "GIRCalculator" (one word) that lets you calculate all your drips together and give you a total GIR. You always have to consider the various drips and meds, as most of them in preemies are mixed in D5w... which for a micropreemie can make up a significant amount of GIR. Your basic GIR calculation is: % of dextrose in solution x rate x 0.167 divided by weight in kilos.

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