Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children – a case series

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.

Glycaemic Imbalances in Seizures and Epilepsy of Paediatric Age: A Literature Review

“…Seizures would especially occur after brisk glucose elevation in predisposed individuals, such as preterm infants who have a decreased ability to suppress endogenous glucose production, immature insulin response to glucose, and limited glycogen and fat stores. Bruns et al [ 108 ] described a cohort of newborns and children with severe iatrogenic hyperglycaemia; in their study, the occurrence of seizure was inevitably associated with coma and unfavourable neurological outcome. The seizure semiology in these children has not been systematically addressed.…”

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

“…Hyperglycaemia can also cause cerebral oedema. According to a recent study in paediatric patients with a blood sugar of more than 16.7 mmol.l −1 , there is a correlation between high blood glucose levels and increased mortality [6]. In addition, hyperglycaemia increases plasma osmolality, which when accompanied by dehydration can cause hyperammonemia in patients with OTCD, especially during cardiac surgery where the volume status can change rapidly.…”

Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology

“…Iatrogenic illnesses are frequent and are the result of errors in type of drug, dose, route of administration or patients in a hospital setting. The first case series about iatrogenic severe hyperglycemia (ISH), defined as glycemia > 300 mg/dl, caused by parenteral administration of glucose were reported by Bruns et al [ 174 ]. ISH [ 175 ] was found in 11 patients, ranging from premature infants to children.…”