Hyperglycaemia of stress in Paedriatrics

Abstract

Glucose levels rise early in response to an acute illness, but what is not clear are the limits of this increase according to the level of metabolic stress in children. 

Objectives: To study glycaemia in paedriatric patients with an acute metabolic stress. 

Patients and methods: 107 children, aged between 29 days and 13 years were recruited in the Emergency unit before the administration of drugs or glucose solutions and classified according to disease and level of metabolic stress (MS): MS low (n = 22), intermediate (n = 46) or severe (n = 23). We study prospectively glucose levels and analyze it according to age (younger or older than 2 years), level of MS, associated pathology. A group of outpatients without an acute illness were used as controls. Temperature and the CRP were used as markers of stress. Anthropometric tables and the z point of standard NCHS tables were used to assess nutritional status. Stadistics analysis were done using ANOVA and univariated correlation coefficient. 

Results: The glucose levels were for the low group 89.9 mg/dl, (SD 17.7), intermediate 97.7 mg/dl (SD 22.9) and severe 112.8 (SD 29.4). There was no relation between the CRP and glucose level in the different groups, but increases of 8.7 mg/l, 33.8 mg/l and 45.6 mg/l respectively for low, intermediate and severe groups. While there was no correlation between glucose level, PCR and temperature there was a tendency of higher temperatures in children in the intermediate and severe groups. The maximum glucose levels were 177 mg/dl in the severe group. Levels above 110 mg/dl were observed in 9% (2/22) in the low group, 19.6% (9/46) in the intermediate and 60% (14/23) in the severe, the maximum level in the control group was 105 mg/dl. In the controls, there was a non significant increase in the glucose level according to age. 

Conclusions: A tendency to greater glycaemias in intermediate and severe metabolic group (NS) and hight risk of hiperglicemia in these groups vs low group and controls were found. Hiperglicemia was not correlated with other stress markers such as CRP or fever. The response is similar at all ages studied and levels above 180 mg/dl should be considered outside of acceptable levels.