Glycaemic management in a child with ornithine transcarbamylase deficiency undergoing cardiac surgery with hypothermic cardiopulmonary bypass

Abstract

There is a lack of evidence regarding the optimal intra-operative glycaemic level of patients with ornithine transcarbamylase deficiency to prevent cerebral oedema due to protein catabolism and hyperammonemia. We describe a case of a two-year-old girl with ornithine transcarbamylase deficiency who underwent cardiac surgery requiring cardiopulmonary bypass. A high-dose dextrose infusion to prevent protein catabolism was given throughout surgery, which caused uncontrollable hyperglycaemia unresponsive to high-dose insulin administration. Factors contributing to the hyperglycaemia may have included surgical stress, steroid administration and hypothermia. During invasive surgery, anaesthetists should carefully adjust the rates of dextrose and insulin infusions, guided by close monitoring of blood ammonia, glucose and lactate.

Follow‐up to ‘Glycaemic management in a child with ornithine transcarbamylase deficiency undergoing cardiac surgery with hypothermic cardiopulmonary bypass’

“…In our previous report, we described the occurrence of uncontrollable intra-operative hyperglycaemia (maximum 25.4 mmol.l À1 ), despite high-dose insulin treatment (maximum 0.4 units.kg À1 .h À1 ) [1]. In view of the possibility that steroid administration had contributed to hyperglycaemia and hyperammonaemia, during the subsequent Fontan procedure we decided not to administer steroids.…”

“…e previously reported the case of a 2-year-old girl with ornithine transcarbamylase deficiency (OTCD) who developed uncontrollable hyperglycaemia during a Glenn procedure with hypothermic cardiopulmonary bypass (CBP), despite the use of a high-dose insulin infusion [1]. This was attributed to steroid administration, surgical stress and dextrose overload.…”