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Kyomugisa B, Were TP, Rujumba J, Munube D, Lorraine O, Kiguli S. "Prevalence, outcome and factors associated with dysglycemia among critically ill children presenting to Fort Portal Regional Referral Hospital: A cross sectional study". RESEARCH SQUARE 2023:rs.3.rs-2734736. [PMID: 37205509 PMCID: PMC10187377 DOI: 10.21203/rs.3.rs-2734736/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Introduction Dysglycemia has been shown to influence outcome among critically ill children. We aimed to determine the prevalence, outcome and factors associated with dysglycemia among critically ill children aged one month to 12 years presenting to Fort Portal regional referral hospital. Methods The study employed a descriptive, cross-sectional design for prevalence and factors associated, and longitudinal observational study design to determine the immediate outcome. Critically ill children aged one month to 12 years were systematically sampled and triaged at outpatient department using World Health Organization emergency signs. The random blood glucose was evaluated on admission and at 24 hours. Verbal and written informed consent/assent were obtained after stabilization of the study participants. Those that had hypoglycemia were given Dextrose 10% and those with hyperglycemia had no intervention. Results Of the 384 critically ill children, dysglycemia was present in 21.7% (n = 83), of those 78.3% (n = 65) had hypoglycemia and 21.7% (n = 18) had hyperglycemia. The proportion of dysglycemia at 24 hours was 2.4% (n = 2). None of the study participants had persistent hypoglycemia at 24 hours. The cumulative mortality at 48hours was 3.6% (n = 3). At 48 hours 33.2% (n = 27) had stable blood glucose levels and were discharged from the hospital. After multiple logistic regression, obstructed breathing (AOR 0.07(0.02-0.23), inability to breastfeed/drink (AOR 2.40 (1.17-4.92) and active convulsions (AOR 0.21 (0.06-0.74), were the factors that were significantly associated with dysglycemia among critically ill children. The results will guide in the revision of policies and treatment protocols to facilitate better management of children at risk of dysglycemia nationally. Conclusions Dysglycemia was found to affect one in five critically ill children aged one month to 12 years presenting to Fort Portal Regional Referral Hospital. Dysglycemia outcomes are good with early intervention.
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Affiliation(s)
- Beatrice Kyomugisa
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Thereza Piloya Were
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Joseph Rujumba
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Deogratious Munube
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Oriokot Lorraine
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, College of Health sciences, Makerere University, P.O BOX 7072 Kampala, Uganda
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Libman I, Haynes A, Lyons S, Pradeep P, Rwagasor E, Tung JYL, Jefferies CA, Oram RA, Dabelea D, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1160-1174. [PMID: 36537527 DOI: 10.1111/pedi.13454] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ingrid Libman
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sarah Lyons
- Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Praveen Pradeep
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Edson Rwagasor
- Rwanda Biomedical Center, Rwanda Ministry of Health, Kigali, Rwanda
| | - Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Craig A Jefferies
- Starship Children's Health, Te Whatu Ora Health New Zealand, Auckland, New Zealand
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maria E Craig
- The Children's Hospital at Westmead, Sydney, New South Wales (NSW), Australia.,University of Sydney Children's Hospital Westmead Clinical School, Sydney, NEW, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine & Health, Sydney, NSW, Australia
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Sehgal M, Batra M, Jha P, Sanchez O. Risk Factors and Laboratory Findings Associated With Diabetic Ketoacidosis in Hospitalized Pediatric Patients. Cureus 2022; 14:e25410. [PMID: 35769689 PMCID: PMC9233933 DOI: 10.7759/cureus.25410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Diabetic ketoacidosis (DKA), the most serious and acute complication of type 1 diabetes, has an incidence of 6%-8% among known pediatric type 1 diabetes patients, although risk factors associated with severe DKA in the pediatric population are poorly understood [1]. Method: A single-institution, retrospective chart analysis of pediatric DKA patients admitted to our pediatric intensive care unit (PICU) was conducted in South Alabama between October 2017 and April 2021. Laboratory findings were obtained from venous samples collected from the patients on admission. Results: Of 429 admissions, 256 unique patients were admitted with DKA to PICU during the 3.5-year period; 55.9% of them were males. The median (IQR) age of the patients was 12 (10-15) years, and their median HbA1c level was 11.02 (10%-12%), which was similar to Medicaid and private insurance statistics (11.1 [9.87-12.2] vs 11 [9.65-12], p = 0.4). Serum pH on presentation was 7.17 (7.08-7.25), and serum bicarbonate was 10 (7-14) mmol/L. White blood cell (WBC) count, platelet count, and mean platelet volume (MPV) had a negative correlation with serum pH (r = -0.52, p < 0.001, r = -0.25, p = 0.01 and r = -0.11, p = 0.03, respectively). The blood urea nitrogen (BUN):creatinine ratio had a positive correlation with serum pH (r = 0.16, p < 0.001). Twenty-nine admissions (6.8%) with a median age of 16 (13-17) years required imaging for altered mental status, and none of these patients were diagnosed with cerebral edema. Conclusion: DKA is associated with noncompliance among pediatric patients, irrespective of their type of insurance. Markers of oxidative stress (WBC, platelets, and MPV) were associated with increased severity of DKA. The BUN:creatinine ratio may not provide accurate hydration status among DKA patients. Clinicians need to have a lower threshold for head imaging among younger patients.
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Association between Stress Hyperglycemia and Adverse Outcomes in Children Visiting the Pediatric Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040505. [PMID: 35455548 PMCID: PMC9026823 DOI: 10.3390/children9040505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Stress hyperglycemia (SH) is often identified in patients visiting the pediatric emergency department (PED), and SH in adults has been associated with adverse outcomes, including mortality. In this retrospective study, we determined the adverse outcomes according to blood glucose (BG) levels of children visiting the PED of tertiary hospitals. Data were collected from the electronic medical records of children aged <18 years between 1 January 2011 and 31 December 2020. A total of 44,905 visits were included in the analysis. SH was identified in 1506 patients, with an incidence rate of 3.4%. Compared to those without SH, patients with SH had significantly higher ward admission rates (52.6% vs. 35.9%, p < 0.001), intensive care unit admission rates (2.6% vs. 0.7%, p < 0.001), and mortality rates (2.7% vs. 0.3%, p < 0.001). Compared to the normoglycemic group of 45 ≤ BG < 150 mg/dL, the odds ratios (95% CI) for mortality were 5.61 (3.35−9.37), 27.96 (14.95−52.26), 44.22 (17.03−114.82), and 39.94 (16.31−97.81) for levels 150 ≤ BG < 200, 200 ≤ BG < 250, 250 ≤ BG < 300 and ≥300 mg/dL, respectively. This suggests that SH is common in children visiting the PED and is associated with higher adverse outcomes. Thus, there is a need to quickly identify its cause and take prompt intervention to resolve it.
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Prevalence and Prognostic Factors of Stress Hyperglycemia in a Pediatric Population with Acute Illness in Greece-A Prospective Observational Study. J Clin Med 2022; 11:jcm11051301. [PMID: 35268392 PMCID: PMC8911079 DOI: 10.3390/jcm11051301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/12/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: stress hyperglycemia (SH) is a relatively frequent finding in pediatric patients. The purpose of this prospective observational study was to identify the prevalence of pediatric SH and its associated risk factors in Greece. Methods: A total of 1005 patients without diabetes who were admitted consecutively for acute illness in a Pediatric Emergency Department were included in the study. Medical history, anthropometric measurements, blood glucose levels, and the medication administered were recorded. A questionnaire was distributed to parents regarding medical and perinatal history and sociodemographic characteristics. Results: There were 72 cases of SH on admission (7.2%) and 39 (3.9%) during hospitalization. Mean age was 6.4 years; 50.3% were male. SH on admission was associated with oral corticosteroid therapy (21.1% vs. 4.7%, p < 0.001), inhaled corticosteroids (12.7% vs. 3%, p < 0.001), and inhaled β2-agonists (30.6% vs. 10.7%, p < 0.001). In-hospital hyperglycemia was associated with oral corticosteroids (adjusted OR = 3.32), inhaled corticosteroids (OR = 10.03) and inhaled β2-agonists (OR = 5.01). Children with asthma were 5.58 and 7.86 times more likely to present admission and in-hospital hyperglycemia, respectively. Conclusions: This is the first report of SH prevalence in pediatric patients in Greece. Asthma, corticosteroids, and β2-agonists significantly increase the risk of SH. No parental factors seem to predispose to SH.
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Markowich AH, Nocentini G, Schingo PMS, Deidda A. Child with intestinal volvulus misdiagnosed as diabetic ketoacidosis. BMJ Case Rep 2021; 14:e243858. [PMID: 34598961 PMCID: PMC8488711 DOI: 10.1136/bcr-2021-243858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Anna Hermine Markowich
- University Department of Pediatrics, University of Rome Tor Vergata, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giulia Nocentini
- University Department of Pediatrics, University of Rome Tor Vergata, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Andrea Deidda
- Pediatric Emergency Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Stress hyperglycemia as first sign of asymptomatic type 1 diabetes: an instructive case. BMC Pediatr 2021; 21:335. [PMID: 34362315 PMCID: PMC8343951 DOI: 10.1186/s12887-021-02811-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Stress hyperglycemia (SH) is considered a transient manifestation and routine diagnostic evaluation was thought to be unnecessary due to the lack of definite correlation with diabetes mellitus (DM). Although SH was usually benign and long-term treatment was superfluous, it might be the first sign of insulinopenic status such as type 1 DM (T1DM). Case presentation We reported a boy with acute asthma attack presented incidentally with high blood glucose levels exceeding 300 mg/dL and obvious glycemic variability. A prolonged hyperglycemic duration of more than 48 h was also noticed. To elucidate his unique situation, glucagon test and insulin autoantibody survey were done which showed insulinopenia with positive anti-insulin antibody and glutamic acid decarboxylase antibody despite the absence of overt DM symptoms and signs. Conclusions This case highlights that SH might be a prodromal presentation in T1DM children, especially when accompanied simultaneously with extreme hyperglycemia, apparent glucose variability, as well as prolonged hyperglycemic duration.
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Knopp JL, Chase JG, Shaw GM. Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU. Ther Adv Endocrinol Metab 2021; 12:20420188211012144. [PMID: 34123348 PMCID: PMC8173630 DOI: 10.1177/20420188211012144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/02/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Critical care populations experience demographic shifts in response to trends in population and healthcare, with increasing severity and/or complexity of illness a common observation worldwide. Inflammation in critical illness impacts glucose-insulin metabolism, and hyperglycaemia is associated with mortality and morbidity. This study examines longitudinal trends in insulin sensitivity across almost a decade of glycaemic control in a single unit. METHODS A clinically validated model of glucose-insulin dynamics is used to assess hour-hour insulin sensitivity over the first 72 h of insulin therapy. Insulin sensitivity and its hour-hour percent variability are examined over 8 calendar years alongside severity scores and diagnostics. RESULTS Insulin sensitivity was found to decrease by 50-55% from 2011 to 2015, and remain low from 2015 to 2018, with no concomitant trends in age, severity scores or risk of death, or diagnostic category. Insulin sensitivity variability was found to remain largely unchanged year to year and was clinically equivalent (95% confidence interval) at the median and interquartile range. Insulin resistance was associated with greater incidence of high insulin doses in the effect saturation range (6-8 U/h), with the 75th percentile of hourly insulin doses rising from 4-4.5 U/h in 2011-2014 to 6 U/h in 2015-2018. CONCLUSIONS Increasing insulin resistance was observed alongside no change in insulin sensitivity variability, implying greater insulin needs but equivalent (variability) challenge to glycaemic control. Increasing insulin resistance may imply greater inflammation and severity of illness not captured by existing severity scores. Insulin resistance reduces glucose tolerance, and can cause greater incidence of insulin saturation and resultant hyperglycaemia. Overall, these results have significant clinical implications for glycaemic control and nutrition management.
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Affiliation(s)
| | - J. Geoffrey Chase
- Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand
| | - Geoffrey M. Shaw
- Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand
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Argyropoulos T, Korakas E, Gikas A, Kountouri A, Kostaridou-Nikolopoulou S, Raptis A, Lambadiari V. Stress Hyperglycemia in Children and Adolescents as a Prognostic Indicator for the Development of Type 1 Diabetes Mellitus. Front Pediatr 2021; 9:670976. [PMID: 33981655 PMCID: PMC8107212 DOI: 10.3389/fped.2021.670976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
Hyperglycemia is a common manifestation in the course of severe disease and is the result of acute metabolic and hormonal changes associated with various factors such as trauma, stress, surgery, or infection. Numerous studies demonstrate the association of adverse clinical events with stress hyperglycemia. This article briefly describes the pathophysiological mechanisms which lead to hyperglycemia under stressful circumstances particularly in the pediatric and adolescent population. The importance of prevention of hyperglycemia, especially for children, is emphasized and the existing models for the prediction of diabetes are presented. The available studies on the association between stress hyperglycemia and progress to type 1 diabetes mellitus are presented, implying a possible role for stress hyperglycemia as part of a broader prognostic model for the prediction and prevention of overt disease in susceptible patients.
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Affiliation(s)
| | - Emmanouil Korakas
- Second Department of Internal Medicine and Research Institute, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Athanasios Raptis
- Second Department of Internal Medicine and Research Institute, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Bruns N, Große Lordemann A, Rasche T, Meyburg J, Krüger M, Wieg C, Gratopp A, Hoppenz M, Heitmann F, Hoppen T, Löffler G, Felderhoff-Müser U, Dohna-Schwake C. Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children - a case series. Ital J Pediatr 2020; 46:179. [PMID: 33261643 PMCID: PMC7709336 DOI: 10.1186/s13052-020-00939-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Iatrogenic severe hyperglycemia (ISH) caused by glucose-containing i.v. solution is a potentially fatal treatment error. The objective of this study was to investigate the causes, circumstances, course of disease, and complications of ISH > 300 mg/dl (16.7 mmol/l) in neonates and children. Methods We emailed a survey to 105 neonatal and pediatric intensive care units in Germany, Austria, and Switzerland, asking to retrospectively report cases of ISH. Results We received 11 reports about premature infants to children. Four patients (36%) had poor outcome: 2 died and 2 suffered persistent sequelae. The highest observed blood glucose was at median 983 mg/dl (54.6 mmol/l) (range 594–2240 mg/dl; 33.0–124.3 mmol/l) and median time to normoglycemia was 7 h (range 2–23). Blood glucose was higher and time to normoglycemia longer in patients with poor outcome. Invasive therapy was required in 73% (mechanical ventilation) and 50% (vasopressor therapy) of patients, respectively. Administration of insulin did not differ between outcome groups. Patients with poor outcome showed coma (100% vs. 40%) and seizures (75% vs. 29%) more frequently than those with good outcome. Conclusions ISH is a severe condition with high morbidity and mortality. Further research to amplify the understanding of this condition is needed, but focus should largely be held on its prevention.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Anja Große Lordemann
- Emergency Department, Children's Hospital Hamburg-Altona, Bleickenallee 38, 22763, Hamburg, Germany
| | - Tobias Rasche
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jochen Meyburg
- Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Marcus Krüger
- Department of Neonatology, Munich Clinic Campus Harlaching and Schwabing, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Christian Wieg
- Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Am Hasenkopf, 63739, Aschaffenburg, Germany
| | - Alexander Gratopp
- Division of Pediatric Emergency and Intensive Care Medicine, Charité University Medical Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marc Hoppenz
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital, Amsterdamer Str. 59, 50735, Cologne, Germany
| | - Friedhelm Heitmann
- Department of Pediatrics, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Thomas Hoppen
- Department of Pediatrics, Gemeinschaftsklinikum Mittelrhein, Koblenzer Str. 115-155, 56073, Koblenz, Germany
| | - Günther Löffler
- Department of Pediatric and Neonatal Intensive Care, University Hospital of Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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Stress Hyperglycemia as Predictive Factor of Recurrence in Children with Febrile Seizures. Brain Sci 2020; 10:brainsci10030131. [PMID: 32120784 PMCID: PMC7139396 DOI: 10.3390/brainsci10030131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 01/04/2023] Open
Abstract
Stress hyperglycemia and hyperlactatemia are commonly referred to as markers of stress severity and poor outcome in children with severe acute illness or febrile seizures. Our prospective study aimed to explore the risk factors for stress hyperglycemia and the predictive value of stress hyperglycemia for febrile seizure recurrence. We evaluated as risk factors for blood glucose level, serum lactate, acid–base status, and the clinical parameters relevant to the severity of the infectious context or to febrile seizure event: fever degree, fever duration, seizure type and aspect, seizure duration, and recurrence. Among 166 febrile seizures events in 128 children, the prevalence of stress hyperglycemia (blood glucose >140 mg/dl) was 16.9%. The comparison of the stress versus non-stress hyperglycemia groups revealed lower pH (median (interquartile range): 7.46 (7.37, 7.53) vs. 7.48 (7.42, 7.53), p = 0.049), higher lactate levels (30.50 mg/dl (15, 36) vs. 19.50 mg/dl (15, 27), p = 0.000), slightly lower HCO3 (20.15 (20.20, 21.45) vs. 21.35 (20, 22.40), p = 0.020) in the stress hyperglycemia group. Multiple logistic regression analysis showed that prolonged febrile seizures (>15 min), recurrent febrile seizure (>1 seizure), focal seizure type, body temperature ≥39.5 °C and higher lactate values were significantly associated with stress hyperglycemia. These findings suggest a particular acute stress reaction in febrile seizures, with stress hyperglycemia playing an important role, particularly in patients with a recurrent seizure pattern. A more complex future approach linking pathogenic mechanisms and genetic traits would be advised and could provide further clues regarding recurrence pattern and individualized treatment.
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Tsai YW, Wu SC, Huang CY, Hsu SY, Liu HT, Hsieh CH. Impact of stress-induced hyperglycemia on the outcome of children with trauma: A cross-sectional analysis based on propensity score-matched population. Sci Rep 2019; 9:16311. [PMID: 31705033 PMCID: PMC6841921 DOI: 10.1038/s41598-019-52928-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Pediatric Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan
| | - Chun-Ying Huang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan
| | - Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan
| | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, 83301, Taiwan.
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Tumwebaze A, Kiboneka E, Mugalu J, Kikabi EM, Tumwine JK. Prevalence and outcome of stress hyperglycaemia among severely malnourished children admitted to Mulago referral and teaching hospital in Kampala, Uganda. BMC Nutr 2018; 4:49. [PMID: 32153910 PMCID: PMC7050710 DOI: 10.1186/s40795-018-0258-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background Stress hyperglycaemia is a transient increase in blood glucose level during stressful events and is common in critically ill children. Several studies have demonstrated increased risk of mortality in these children. There is paucity of information on this subject in sub Saharan Africa.The aim of this study was to describe the prevalence, outcome and factors associated with stress hyperglycaemia among children with severe acute malnutrition (SAM) admitted to the Mwanamugimu nutrition unit of Mulago hospital in Uganda. Methods This study was conducted from August 2015 to March 2016 at the Mwanamugimu nutrition unit of Mulago hospital among severely malnourished children aged 1 to 60 months. Random blood sugar levels were measured. Stress hyperglycaemia was considered as a random blood sugar > 150 mg/dl. The final outcome was ascertained at death or discharge. Statistical analysis was done using the Chi square test and logistic regression. Results Two hundred and thirty-five children were enrolled of whom 50% were girls. The median age was 5.1 months (range 1-60 months). Stress hyperglycaemia was present in 16.6% of the 235 participants. Several factors were significantly associated with stress hyperglycaemia at bivariate analysis; but on logistic regression, only presence of oral sores was associated with stress hyperglycaemia: (Odds ratio 2.61; 95% CI 1.02-6.65).Mortality was higher among children with stress hyperglycaemia (56.4%) compared to (12.8%) in the non-hyperglycaemic group: OR 8.75; 95% CI 4.09-18.70). Conclusion The prevalence of stress hyperglycaemia was 16.6% and was associated with high mortality. It is important to monitor blood glucose levels of severely malnourished children. Hitherto, the main concern among severely malnourished children has been hypoglycaemia. Innovative ways of preventing and managing stress hyperglycaemia among these children are urgently needed.
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Affiliation(s)
- Anita Tumwebaze
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elizabeth Kiboneka
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jamir Mugalu
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edward M Kikabi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Fattorusso V, Nugnes R, Casertano A, Valerio G, Mozzillo E, Franzese A. Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat? Curr Diab Rep 2018; 18:140. [PMID: 30370431 DOI: 10.1007/s11892-018-1115-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Non-diabetic hyperglycemia (NDHY) is a pathological condition that is not yet well known. The aim of this review is to examine approaches for management of this condition. RECENT FINDINGS While it is well known that persistent hyperglycemia in diabetes affects immune response and risk for diabetes-related micro- and macrovascular complications, little is known about the biological effects of transient NDHY, particularly in the pediatric age group. Stress HY (SHY) is typically defined as blood glucose > 8.33 mmol/L (150 mg/dL) during physical stress, resolving spontaneously after dissipation of acute illness in patients without known diabetes. Based on the literature and clinical practice, two situations can be classified: (1) SHY1, which occurs during severe and prolonged illness and under serious life-threatening conditions, mainly in emergency situations and in resuscitation areas; and (2) SHY2, which occurs during acute illness, mainly in non-life-threatening conditions. Furthermore, (NDHY) among pediatric patients can be induced by drugs; the most frequent conditions are secondary to (1) steroid therapy and (2) antineoplastic/immunosuppressive therapy.
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Affiliation(s)
- Valentina Fattorusso
- Department of Translational Medical Science (DISMET), Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Rosa Nugnes
- Department of Translational Medical Science (DISMET), Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Alberto Casertano
- Department of Translational Medical Science (DISMET), Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University, Naples, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science (DISMET), Section of Pediatrics, University of Naples Federico II, Naples, Italy.
| | - Adriana Franzese
- Department of Translational Medical Science (DISMET), Section of Pediatrics, University of Naples Federico II, Naples, Italy
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15
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Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, Aschner P, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:7-19. [PMID: 30226024 PMCID: PMC7521365 DOI: 10.1111/pedi.12773] [Citation(s) in RCA: 313] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Craig Jefferies
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Naby Balde
- Department of Endocrinology, University Hospital, Conakry, Guinea
| | - Chun X. Gong
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | | | - Maria E. Craig
- The Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia,School of Women’s and Children’s Health, University of NSW, Sydney, New South Wales, Australia
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16
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Shi Y, Xue J, Sang Y, Xu X, Shang Q. Insulin-loaded hydroxypropyl methyl cellulose-co-polyacrylamide-co-methacrylic acid hydrogels used as rectal suppositories to regulate the blood glucose of diabetic rats. Int J Biol Macromol 2018; 121:1346-1353. [PMID: 30208299 DOI: 10.1016/j.ijbiomac.2018.09.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/03/2018] [Accepted: 09/09/2018] [Indexed: 01/05/2023]
Abstract
The purpose of this study was developing a novel hydroxypropyl methyl cellulose-co-polyacrylamide-co-methacrylic acid (HPMC-co-PAM-co-PMAA) hydrogel, which was used as rectal suppository to regulate the blood glucose of diabetes. HPMC-co-PAM-co-PMAA hydrogel was fabricated via free-radical polymerization. Fourier transform infrared spectroscopy (FTIR) and Raman spectra were used to confirm the fabrication of HPMC-co-PAM-co-PMAA hydrogel. Their inner morphology was observed with scanning electron microscope (SEM). The extracts of hydrogel were applied to study their cell viability. The hypoglycemic effects of insulin (INS)-loaded HPMC-co-PAM-co-PMAA hydrogels were investigated by rectal administration. FTIR and Raman spectra confirmed the obtaining of HPMC-co-PAM-co-PMAA hydrogels. Many micro-pores were found in the SEM photograph of HPMC-co-PAM-co-PMAA hydrogels. Cell experiments indicated that HPMC-co-PAM-co-PMAA hydrogel was out of cytotoxicity. In vitro release profiles showed that INS-loaded hydrogel could release INS at a continuous manner in pH 7.4 buffer (rectal conditions). Animal experiments suggested that INS-loaded hydrogel had an obvious hypoglycemic effect. Therefore, as a convenient and economic method of administration, INS-loaded HPMC-co-PAM-co-PMAA hydrogels could be used as rectal suppositories to regulate blood glucose.
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Affiliation(s)
- Yongli Shi
- College of pharmacy, Xinxiang Medical University, 453003 Xinxiang, PR China.
| | - Jintao Xue
- College of pharmacy, Xinxiang Medical University, 453003 Xinxiang, PR China
| | - Yajun Sang
- College of pharmacy, Xinxiang Medical University, 453003 Xinxiang, PR China
| | - Xiaoqing Xu
- College of pharmacy, Xinxiang Medical University, 453003 Xinxiang, PR China
| | - Qing Shang
- School of Chemical and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang 050018, PR China
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17
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Hale AT, Pekala K, Theobald B, Kelly K, Wolf M, Wellons JC, Le T, Shannon CN. Predictors of post-discharge seizures in children with traumatic brain injury. Childs Nerv Syst 2018; 34:1361-1365. [PMID: 29564537 DOI: 10.1007/s00381-018-3779-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/15/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE In traumatic brain injury (TBI), hyperglycemia and hypothermia are thought to be associated with poor outcomes, but have not been systematically studied in children. Thus, our aim was to evaluate whether serum glucose and temperature at admission, among other clinical variables, were associated with need for post hospital-discharge seizure medication in children diagnosed with TBI. METHODS We performed a retrospective study of 1814 children who were diagnosed with TBI at a tertiary pediatric hospital. Serum glucose levels at admission and temperature at initial presentation, 12, and 24 h were collected. Ongoing seizure activity was defined as discharge prescription of a seizure-modifying medication. RESULTS We identified 121 patients with need for continued seizure medications, and 80 patients expired. Independent predictors of prolonged seizures included serum glucose levels above 140 mg/dl (p < 0.003) and 199 mg/dl (p < 0.001), hypothermia (<35 °C), subdural hematoma (p < 0.001), midline shift (p < 0.001), and > 1% temperature change in the first 24 h (p < 0.001). Multivariate regression adjusting for GCS revealed that bilateral bleed (p = 0.008), body-temperature instability (p = 0.026), subdural hematoma (p < 0.001), and mechanism of injury (p = 0.007) were predictive of prolonged seizure activity. CONCLUSIONS In summary, we conclude that body temperature may be playing a more significant role than glycemic control in propensity for ongoing seizure activity in children sustaining TBI.
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Affiliation(s)
- Andrew T Hale
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA. .,Vanderbilt University School of Medicine, 2200 Pierce Avenue, 610 RRB, Nashville, TN, 37232, USA.
| | - Kelly Pekala
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.,Vanderbilt University School of Medicine, 2200 Pierce Avenue, 610 RRB, Nashville, TN, 37232, USA
| | - Benjamin Theobald
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.,Vanderbilt University School of Medicine, 2200 Pierce Avenue, 610 RRB, Nashville, TN, 37232, USA
| | - Katherine Kelly
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA
| | - Michael Wolf
- Department of Pediatrics, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA
| | - John C Wellons
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.,Department of Neurological Surgery, Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Truc Le
- Department of Pediatrics, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.,Department of Neurological Surgery, Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital at Vanderbilt University, Nashville, TN, USA.,Department of Neurological Surgery, Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Hyperglycemia in Acutely Ill Non-diabetic Children in the Emergency Rooms of 2 Tertiary Hospitals in Lagos, Nigeria. Pediatr Emerg Care 2016; 32:608-13. [PMID: 27589386 DOI: 10.1097/pec.0000000000000440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The study aimed to determine the prevalence of hyperglycemia in sick children admitted into the emergency rooms and to investigate its relationship with adverse outcomes. METHODS A prospective study involving 2 tertiary hospitals in Lagos. Study subjects included all children aged beyond 1 month. An Accu-Chek Active glucometer was used for the bedside blood glucose determination. Hyperglycemia was defined as blood glucose greater than 7.8 mmol/L. RESULTS A total of 1045 patients were recruited with hyperglycemia being recorded in 135 patients (prevalence rate of 12.9%). Mean age of the hyperglycemic patients was 29.0 ± 31.23 months. Prevalence rates of hyperglycemia among the leading diagnoses were 17.4% in acute respiratory tract infections, 11% in malaria, 15.3% in septicemia, 14.9% in gastroenteritis, and 18.2% in burns. Other conditions include sickle cell anemia, meningitis, and malnutrition. Mortality rate was significantly higher overall in hyperglycemic compared with the normoglycemic patients (15.4% vs 8.0%, P = 0.011). With regard to specific diagnoses, significantly higher mortality rates were recorded in hyperglycemic patients with acute respiratory tract infections (28% vs 8%, P = 0.011) and malaria (21.4% vs 5.0%, P = 0.006) than in their normoglycemic counterparts. CONCLUSIONS Hyperglycemia is common in ill children admitted to the emergency rooms and is associated with 2 to 4 times higher mortality in common childhood diseases encountered. Blood glucose determination is important in all acutely ill children at presentation. The practice of empirical administration of intravenous glucose in some resource-constrained facilities where blood glucose testing facilities are not readily available should be discouraged.
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19
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Marano M, Lonati D, Locatelli CA, Pisani M. Letter in response to: “Hyperglycemia is a risk factor for high-grade envenomations after European viper bites ( Vipera spp.) in children”. Clin Toxicol (Phila) 2016; 54:539. [DOI: 10.3109/15563650.2016.1166374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Marco Marano
- Pediatric Intensive Care Unit, IRCCS “Bambino Gesù” Children Hospital, Piazza Sant'Onofrio, 4, Rome, Italy
| | - Davide Lonati
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, via Maugeri, 10, Pavia, 27100, Italy
| | - Carlo Alessandro Locatelli
- Poison Control Centre and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation Hospital and University of Pavia, via Maugeri, 10, Pavia, 27100, Italy
| | - Mara Pisani
- Emergency Department, IRCCS “Bambino Gesù” Children Hospital, Piazza Sant'Onofrio, 4, Rome, Italy
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20
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Lee JY, Kim JH, Cho HR, Lee JS, Ryu JM, Yum MS, Ko TS. Children Experiencing First-Time or Prolonged Febrile Seizure Are Prone to Stress Hyperglycemia. J Child Neurol 2016; 31:439-43. [PMID: 26239487 DOI: 10.1177/0883073815597757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/30/2015] [Indexed: 11/16/2022]
Abstract
The risk factors and clinical implications of stress hyperglycemia in children with febrile seizure remain uncertain. Among 479 children with febrile seizure, the prevalence of the stress hyperglycemia (blood glucose concentration ≥ 150 mg/dL) was 10.0%. Stress hyperglycemia group included larger proportion of first-time febrile seizure, prolonged febrile seizure, and smaller proportion of short febrile seizure in comparison with the non-stress hyperglycemia group. Stress hyperglycemia group demonstrated a lower pH and higher lactate levels than the non-stress hyperglycemia group. Multivariate analysis revealed that first-time febrile seizure (aOR = 3.741, P = .004) and prolonged febrile seizure (aOR = 12.855, P < .001) were significant risk factors for stress hyperglycemia. The rate of early febrile seizure recurrence in the emergency department was not different between the groups. These findings suggest that children experiencing first-time or prolonged febrile seizure are prone to stress hyperglycemia, and this can be related to febrile seizure severity. However, stress hyperglycemia is not predictive of early febrile seizure recurrence in the emergency department.
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Affiliation(s)
- Jeong-Yong Lee
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jung-Heon Kim
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hyung-Rae Cho
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jong-Seung Lee
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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21
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Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:4-17. [PMID: 25182305 DOI: 10.1111/pedi.12186] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead and University of Sydney, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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22
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Greig F, Rapaport R, Klein G, Akler G, Annunziato R, Miloh T, Arnon R, Florman S, Kerkar N. Characteristics of diabetes after pediatric liver transplant. Pediatr Transplant 2013; 17:27-33. [PMID: 22905982 DOI: 10.1111/j.1399-3046.2012.01779.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Studies of DALT in pediatric recipients describe incidence and risk factors, but diagnostic criteria varied. This study reports characteristics and course of pediatric DALT by established diabetes criteria. Retrospective chart review of pediatric LT recipients evaluated for hyperglycemia (1/1/1997-12/30/2009) and matched, non-diabetic controls. DALT: random blood glucose >11.1 mm, ≥ 2 times, with insulin treatment. DALT diagnosed in 8.0% (24/300) included 7/24 (29.2%) with severe hyperglycemia (>27.7 mm), ketoacidosis in 2/24 (8.3%). At diagnosis, age was ≥ 11 yr old in 22/24 (91.7%); body mass was lean (BMIz -0.2 ± 1.5). Mean blood glucose was 24.6 mm with negative diabetes autoantibodies (19/19) and elevated C-peptide (2.3 nm). DALT onset median 5.0 months included 29.1% >12 months. Insulin duration median 4.6 months included 41.7% >6 months. DALT resolved in 83.3% over 4.9 (0.9-9.1) yr. DALT differed from controls by increased preceding rejections, prednisolone dose, tacrolimus level, and triple immunosuppression (all p < 0.01). In conclusion, pediatric DALT occurred in non-obese adolescents with insulin resistance, distinct from diabetes types 1 or 2. DALT was associated with preceding rejection and increased immunosuppression. Blood glucose monitoring, especially during increased immunosuppression following LT, could allow early diagnosis and reduce morbidity.
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Affiliation(s)
- Fenella Greig
- Division of Pediatric Endocrinology and Diabetes, Mount Sinai Medical Center, New York, NY 10029, USA
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23
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Bordbar MR, Taj-Aldini R, Karamizadeh Z, Haghpanah S, Karimi M, Omrani GH. Thyroid function and stress hormones in children with stress hyperglycemia. Endocrine 2012; 42:653-7. [PMID: 22653725 DOI: 10.1007/s12020-012-9707-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/15/2012] [Indexed: 12/26/2022]
Abstract
The purpose of the study is to determine the prevalence of stress hyperglycemia and to investigate how thyroid and stress hormones alter during stress hyperglycemia in children admitted to pediatric emergency wards. A prospective cross-sectional study was conducted in children, less than 19 years old, who were admitted to pediatric emergency wards of Nemazee and Dastgheib Hospitals, Shiraz, Southern Iran. Those patients taking steroids, beta-agonists or intravenously administered glucose before venipuncture, and patients with diabetes mellitus (DM) or thyroid diseases were excluded. Children with blood glucose ≥ 150 mg/dL during admission were regarded as cases. The controls were age- and- sex- matched, euglycemic children. Stress hormones including cortisol, insulin, growth hormone, and prolactin were measured, and thyroid function was tested with a radioimmunoassay (RIA) method in all cases and controls. The results showed that among 1,054 screened children, 39 cases (3.7 %) had stress hyperglycemia and 89 controls were included in the study. The occurrence of hyperglycemia was independent of sex, but it occurred mostly in children under 6 years old. Hyperglycemia occurred more frequently in patients with a positive family history of DM (odds ratio = 3.2, 95 % CI = 1.3-7.9, and P = 0.009). There were no significant differences between cases and controls regarding any hormones except higher cortisol, and lower total T3 and T4 in cases compared with controls. Neither of cases developed diabetes in the 24-month follow-up period. These findings led us to the conclusion that stress hyperglycemia is occasionally seen in critically ill patients. Among the stress hormones measured, only cortisol increased during hyperglycemia. It seems that hyperglycemia is not an important risk factor for future diabetes.
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Glucose metabolism disturbances in acute pediatric illness. Pediatr Emerg Care 2011; 27:452-4. [PMID: 21546818 DOI: 10.1097/pec.0b013e31821c987b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hyperglycemia frequently occurs with acute medical illness, especially among patients with cardiovascular disease, and has been linked to increased morbidity and mortality in critically ill patients. Even patients who are normoglycemic can develop hyperglycemia in response to acute metabolic stress. An expanding body of literature describes the benefits of normalizing hyperglycemia with insulin therapy in hospitalized patients. As a result, both the American Diabetes Association and the American College of Endocrinology have developed guidelines for optimal control of hyperglycemia, specifically targeting critically ill, hospitalized patients. Conventional blood glucose values of 140–180 mg/dL are considered desirable and safely achievable in most patients. More aggressive control to <110 mg/dL remains controversial, but has shown benefits in certain patients, such as those in surgical intensive care. Intravenous infusion is often used for initial insulin administration, which can then be transitioned to subcutaneous insulin therapy in those patients who require continued insulin maintenance. This article reviews the data establishing the link between hyperglycemia and its risks of morbidity and mortality, and describes strategies that have proven effective in maintaining glycemic control in high-risk hospitalized patients.
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Affiliation(s)
- Samer Ellahham
- Samer Ellahham and Associates, Falls Church, VA 22041, USA.
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