Article Sidebar
Main Article Content
Abstract
Introduction. Abnormal blood sugar level (dysglycemia) on admission in severely ill children is metabolic response to acute stress. This is not found in all patients and we hypothesized that in non-diabetic children, abnormal glycaemic profile on admission worsened patient’s evolution in hospital. Materials and methods. We carried out a prospective cohort study in a paediatric emergency unit during 6 months. We included children with a severe acute medical condition, aged between 28 days and 16 years. Blood sugar level was tested in each patient on admission. The data on final diagnosis, evolution were collected. We compared data of children with or without dysglycemia on admission. Pearson’s chi square test and Fisher’s exact test were used to compare categorical variables while Kruskal-Wallis test and Mann Whitney U were used to compare numerical variables. Results. We included 203 children with median age 30 months (IQR: 14-68 months). The prevalence of hypoglycemia on admission was 3.45% and stress hyperglycemia on admission 31.53%. Unconsciousness and respiratory distress were the most frequent symptoms significantly associated with dysglycemia (P<0.05). Children with dysglycemia were 7.1 times more likely to be transferred to the intensive care unit and 7.4 times more likely to die compared to those with a normal glycemia (p<0.01). Conclusion. Dysglycemia occurs in 34.9% of patients admitted in our paediatric emergency unit and was associated with higher risk of mortality.
Keywords
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- Ameyaw E, Amponsah-Achiano K, Yamoah P, Chanoine J-P. Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana. International journal of pediatrics. 2014;2014.
- Badawi O, Waite MD, Fuhrman SA, Zuckerman IH. Association between intensive care unit–acquired dysglycemia and in-hospital mortality. Critical care medicine. 2012;40(12):3180-8.
- Dzeing-Ella A, Obiang PCN, Tchoua R, Planche T, Mboza B, Mbounja M, et al. Severe falciparum malaria in Gabonese children: clinical and laboratory features. Malaria journal. 2005;4(1):1.
- Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al., editors. Hypoglycemia and outcome in critically ill patients. Mayo Clinic Proceedings; 2010: Elsevier.
- Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, McArthur C, et al. Hypoglycemia and risk of death in critically ill patients. The New England journal of medicine. 2012;367(12):1108-18.
- Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006;118(1):173-9.
- Bhisitkul DM, Morrow AL, Vinik AI, Shults J, Layland JC, Rohn R. Prevalence of stress hyperglycemia among patients attending a pediatric emergency department. The Journal of pediatrics. 1994;124(4):547-51.
- Elusiyan J, Adejuyigbe E, Adeodu O. Hypoglycemia in a Nigerian paediatric emergency ward. Journal of tropical pediatrics. 2006;52(2):96-102.
- Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, et al. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. The American journal of tropical medicine and hygiene. 2013;89(2):232-7.
- Valerio G, Franzese A, Carlin E, Pecile P, Perini R, Tenore A. High prevalence of stress hyperglycemia in children with febrile seizures and traumatic injuries. Acta Paediatrica. 2001;90(6):618-22.
- Madrid L, Acacio S, Nhampossa T, Lanaspa M, Sitoe A, Maculuve SA, et al. Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique. The American journal of tropical medicine and hygiene. 2016;94(1):218-26.
- Osier F, Berkley J, Ross A, Sanderson F, Mohammed S, Newton C. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Archives of disease in childhood. 2003;88(7):621-5.
- Bhutia TD, Lodha R, Kabra SK. Abnormalities in glucose homeostasis in critically Ill children. Pediatric Critical Care Medicine. 2013;14(1):e16-e25.
- Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H. Childhood dysglycemia: prevalence and outcome in a referral hospital. PloS one. 2013;8(5):e65193.
- Solomon T, Phillips R, Felix J, Samuel M, Dengo G, Schapira A, et al. Hypoglycemia in paediatric admissions in Mozambique. The Lancet. 1994;343(8890):149-50.
- Willcox ML, Forster M, Dicko MI, Graz B, Mayon‐White R, Barennes H. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycemia’? Tropical Medicine & International Health. 2010;15(2):232-40.
- World health organization. Management of severe malaria- a practical handbook. Third edition. 2013. Available on WHO | Management of severe malaria – A practical handbook. Third edition
- World Health Organization. Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. 2005. Available on WHO | Pocket book of hospital care for children.
- Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr. 2008;153(3):379–384.
- Park BS, Yoon JS, Moon JS, Won KC, Lee HW. Predicting mortality of critically ill patients by blood glucose levels. Diabetes Metab J. 2013;37(5):385–390
- Toro-polo LM, Ortiz-Lozada RY, Chang-Grozo SL, Hernandez AV, Esclante-Kanashiro R, Solari-Zerpa L. Gycemia upon admission and mortality in pediatric intensive care unit. Rev Bras Ter Intensiva 2018; 30(4): 471-478.
References
Ameyaw E, Amponsah-Achiano K, Yamoah P, Chanoine J-P. Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana. International journal of pediatrics. 2014;2014.
Badawi O, Waite MD, Fuhrman SA, Zuckerman IH. Association between intensive care unit–acquired dysglycemia and in-hospital mortality. Critical care medicine. 2012;40(12):3180-8.
Dzeing-Ella A, Obiang PCN, Tchoua R, Planche T, Mboza B, Mbounja M, et al. Severe falciparum malaria in Gabonese children: clinical and laboratory features. Malaria journal. 2005;4(1):1.
Egi M, Bellomo R, Stachowski E, French CJ, Hart GK, Taori G, et al., editors. Hypoglycemia and outcome in critically ill patients. Mayo Clinic Proceedings; 2010: Elsevier.
Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, McArthur C, et al. Hypoglycemia and risk of death in critically ill patients. The New England journal of medicine. 2012;367(12):1108-18.
Wintergerst KA, Buckingham B, Gandrud L, Wong BJ, Kache S, Wilson DM. Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006;118(1):173-9.
Bhisitkul DM, Morrow AL, Vinik AI, Shults J, Layland JC, Rohn R. Prevalence of stress hyperglycemia among patients attending a pediatric emergency department. The Journal of pediatrics. 1994;124(4):547-51.
Elusiyan J, Adejuyigbe E, Adeodu O. Hypoglycemia in a Nigerian paediatric emergency ward. Journal of tropical pediatrics. 2006;52(2):96-102.
Nadjm B, Mtove G, Amos B, Hildenwall H, Najjuka A, Mtei F, et al. Blood glucose as a predictor of mortality in children admitted to the hospital with febrile illness in Tanzania. The American journal of tropical medicine and hygiene. 2013;89(2):232-7.
Valerio G, Franzese A, Carlin E, Pecile P, Perini R, Tenore A. High prevalence of stress hyperglycemia in children with febrile seizures and traumatic injuries. Acta Paediatrica. 2001;90(6):618-22.
Madrid L, Acacio S, Nhampossa T, Lanaspa M, Sitoe A, Maculuve SA, et al. Hypoglycemia and Risk Factors for Death in 13 Years of Pediatric Admissions in Mozambique. The American journal of tropical medicine and hygiene. 2016;94(1):218-26.
Osier F, Berkley J, Ross A, Sanderson F, Mohammed S, Newton C. Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Archives of disease in childhood. 2003;88(7):621-5.
Bhutia TD, Lodha R, Kabra SK. Abnormalities in glucose homeostasis in critically Ill children. Pediatric Critical Care Medicine. 2013;14(1):e16-e25.
Sambany E, Pussard E, Rajaonarivo C, Raobijaona H, Barennes H. Childhood dysglycemia: prevalence and outcome in a referral hospital. PloS one. 2013;8(5):e65193.
Solomon T, Phillips R, Felix J, Samuel M, Dengo G, Schapira A, et al. Hypoglycemia in paediatric admissions in Mozambique. The Lancet. 1994;343(8890):149-50.
Willcox ML, Forster M, Dicko MI, Graz B, Mayon‐White R, Barennes H. Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for ‘hypoglycemia’? Tropical Medicine & International Health. 2010;15(2):232-40.
World health organization. Management of severe malaria- a practical handbook. Third edition. 2013. Available on WHO | Management of severe malaria – A practical handbook. Third edition
World Health Organization. Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. 2005. Available on WHO | Pocket book of hospital care for children.
Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr. 2008;153(3):379–384.
Park BS, Yoon JS, Moon JS, Won KC, Lee HW. Predicting mortality of critically ill patients by blood glucose levels. Diabetes Metab J. 2013;37(5):385–390
Toro-polo LM, Ortiz-Lozada RY, Chang-Grozo SL, Hernandez AV, Esclante-Kanashiro R, Solari-Zerpa L. Gycemia upon admission and mortality in pediatric intensive care unit. Rev Bras Ter Intensiva 2018; 30(4): 471-478.