Marked stress hyperglycemia in a child

Chernow, Bart; Rainey, Thomas G.; Heller, Ross; Clapper, Mark; Labow, Joel

doi:10.1097/00003246-198210000-00018

Cited by 6 publications

(3 citation statements)

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“…Consistent with prior studies of stress hyperglycemia, 2,9–11,15,19 ESH was documented to occur in a wide variety of pediatric diagnoses routinely seen in the ED, with respiratory illness, seizure, and trauma being the most common. Although it was not feasible to differentiate between stress-mediated and iatrogenic hyperglycemia in this study as timing of laboratory assessment and therapeutic interventions was not controlled, preceding medical therapy is likely to have influenced the degree of hyperglycemia in most cases.…”

Section: Discussionsupporting

confidence: 75%

“…1–4 Relative insulin deficiency, 1,5 peripheral insulin resistance, 1,5 and dehydration causing decreased renal perfusion with limitation of urinary glucose excretion 6 may also contribute, as can certain medications. 2,7,8 …”

mentioning

confidence: 99%

“…12–14 Most patients with stress hyperglycemia experience mild to moderate elevations in blood glucose concentration between 150 and 299 mg/dL (8.3 and 16.6 mmol/L), but values of 300 mg/dL (16.7 mmol/L) or higher have also been reported in small numbers in some series 9,11,15 and in case reports. 2,6,14 However, because extreme elevations in glucose concentration in response to stress are unusual in patients without known DM when they present initially to the ED, such a laboratory finding may lead to confusion in diagnosis, management, and prognosis, including a potential misdiagnosis of concurrent new-onset DM or concern for an increased risk of developing diabetes later in life. 9,10,16–19 Furthermore, even if extreme stress hyperglycemia (ESH) can reliably be differentiated from diabetes, it is unknown if this tends to resolve with the simultaneous initiation of treatment of the primary disease process, whether the initiation of insulin in the ED is necessary or beneficial, or if severity of illness is associated with the degree of stress hyperglycemia in the ED, as has been reported in other clinical settings.…”

mentioning

confidence: 99%

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Extreme Stress Hyperglycemia During Acute Illness in a Pediatric Emergency Department

Weiss

Alexander

Agus

2010

Pediatric Emergency Care

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Objectives Although mild stress hyperglycemia in pediatric illness is common, severe hyperglycemic responses (≥300 mg/dL [16.7 mmol/L]) to stress are unusual. We sought to determine the incidence and course of extreme stress hyperglycemia (ESH) in acute pediatric illness, including whether it is a marker of increased mortality or associated with subsequent development of diabetes mellitus (DM). Methods We retrospectively reviewed a cohort of 55,120 consecutive visits over 6 years to a pediatric emergency department at which blood glucose concentrations were measured and report on visits with laboratory glucose 300 mg/dL (16.7 mmol/L) or greater without DM. Results There were 72 cases of ESH (incidence of 0.13%). Median age was 8.8 years; 63% were male. The most common diagnoses were respiratory illness (49%), trauma (15%), and seizure (8%), and 65% of patients had received glucose-influencing interventions before evaluation. Eighty-five percent were ill appearing, 60% were admitted to the intensive care unit, and half had acidemic pH values. The overall mortality rate was 22%. Despite treatment of hyperglycemia in only 8 patients, glucose concentrations decreased to 150 mg/dL (8.3 mmol/L) or less within 48 hours in 67% and before discharge or death in 85% of patients. Preceding symptoms and concurrent laboratory results were helpful to exclude diabetes, and none of the surviving patients with follow-up available went on to develop type 1 or 2 DM. Conclusions Although rare, ESH (≥300 mg/dL [16.7 mmol/L]) does occur in acute pediatric illness, in most cases is at least partially iatrogenic, and is a marker of severe illness and high mortality. Normoglycemia is typically restored quickly with treatment of the primary illness. No association was found with a subsequent diagnosis of DM.

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