Prevalence of stress hyperglycemia among patients attending a pediatric emergency department

Bhisitkul, Donna M.; Morrow, Ardythe L.; Vinik, Aaron I.; Shults, Justine; Layland, Jacqueline C.; Rohn, Reuben D.

doi:10.1016/s0022-3476(05)83132-4

Cited by 50 publications

(35 citation statements)

References 19 publications

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“…The prevalence of hyperglycemia in non-critically ill children seen in the emergency department was much lower, ranging from 3.8% to 5.0% (based on an initial blood glucose >150 mg/ dL). 19,24 In agreement with these studies, we found inpatient hyperglycemia to be a common finding among hospitalized children. Approximately 75% of our patients had a normal blood glucose on admission, 19% had an admission blood glucose of 121-179 mg/dL (mean 143 AE 2 mg/dL), and 5.9% of children had an admission blood glucose !180 mg/dL (mean 260 AE 18 mg/dL).…”

Section: Discussionsupporting

confidence: 90%

“…The few observational studies in critically ill children admitted to the pediatric ICU with severe brain injury or extensive burn injuries have shown a positive association between inpatient hyperglycemia and increased length of hospital and ICU stay and a higher risk of complication and mortality rates. [19][20][21][22][23] No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a general community pediatric hospital. Therefore, in this study we determined the prevalence of inpatient hyperglycemia and examined the impact of hyperglycemia on morbidity and mortality in children admitted to Hughes Spalding Children's Hospital, a large community hospital serving the inner city and indigent pediatric population in Atlanta, Georgia.…”

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confidence: 99%

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Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:Inpatient hyperglycemia in adult patients with and without a history of diabetes is a predictor of poor clinical outcome. No previous studies, however, have examined the association of hyperglycemia and clinical outcome in children admitted to a community pediatric hospital.METHODS:The study was a retrospective observational cohort of pediatric patients admitted to a community children's hospital from January 2004 to August 2004. Medical records of 903 consecutive children admitted to critical and non–critical care areas were reviewed. Of them, 342 patients (38%) had no blood glucose measurements during their hospital stay. In the remaining patients, we determined the prevalence of hyperglycemia and examined the association of hyperglycemia with clinical outcome.RESULTS:A total of 406 patients (75%) had an admission blood glucose ≤120 mg/dL (mean ± SEM 98 ± 1 mg/dL), 103 children (19%) had an admission blood glucose level of 121–179 mg/dL (mean 143 ± 2 mg/dL), and 32 patients (5.9%) had a blood glucose level ≥180 mg/dL (mean 260 ± 18 mg/dL). Seventeen patients (13%) had a known history of diabetes prior to admission. Children with hyperglycemia were more likely to be admitted to the ICU (P < .001) and had a longer length of ICU stay (P < .001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality.CONCLUSIONS:Hyperglycemia is present in one‐fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. Hyperglycemia was associated with a greater need for ICU care and longer ICU stay but not with increased in‐hospital mortality. Journal of Hospital Medicine 2008;3:212–217. © 2008 Society of Hospital Medicine.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Palacio

Smiley

Cerón

et al. 2008

Journal of Hospital Medicine

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“…Incidental hyperglycemia is a relatively common finding in the pediatric population (28). It has been reported that the risk of progression to type 1 diabetes is low when transient hyperglycemia occurs during a serious intercurrent illness (10 -11).…”

Section: Immunogenetic Markersmentioning

confidence: 99%

Risk of Type 1 Diabetes Development in Children With Incidental Hyperglycemia

Lorini

Alibrandi²,

Vitali³

et al. 2001

Diabetes Care

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OBJECTIVE -The aim of our study was to determine whether children with incidental hyperglycemia are at an increased risk of developing type 1 diabetes. RESEARCH DESIGN AND METHODS-A total of 748 subjects, 1-18 years of age (9.04 Ϯ 3.62, mean Ϯ SD), without family history of type 1 diabetes, without obesity, and not receiving drugs were studied and found to have incidental elevated glycemia defined as fasting plasma glucose Ͼ5.6 mmol/l confirmed on two occasions. Subjects were tested for immunological, metabolic, and immunogenetic markers.RESULTS -Islet cell antibodies Ͼ5 Juvenile Diabetes Foundation units were found in 10% of subjects, elevated insulin autoantibody levels in 4.6%, GAD antibody in 4.9%, and antityrosine phosphatase-like protein autoantibodies in 3.9%. First-phase insulin response (FPIR) was Ͻ1st centile in 25.6% of subjects. The HLA-DR3/DR3 and HLA-DR4/other alleles were more frequent in hyperglycemic children than in normal control subjects (P ϭ 0.012 and P ϭ 0.005, respectively), and the HLA-DR other/other allele was less frequent than in normal control subjects (P ϭ 0.000027). After a median follow-up of 42 months (range 1 month to 7 years), 16 (2.1%) subjects (11 males and 5 females), 4.1-13.9 years of age, became insulin dependent. All had one or more islet autoantibodies, and the majority had impaired insulin response and genetic susceptibility to type 1 diabetes. Diabetes symptoms were recorded in 11 patients and ketonuria only in 4 patients. The cumulative risk of type 1 diabetes was similar in males and females, and it was also similar in subjects under or over 10 years, whereas the cumulative risk of type 1 diabetes was increased in subjects with one or more autoantibodies and in those with FPIR Ͻ1st centile.CONCLUSIONS -Children with incidental hyperglycemia have a higher-than-normal frequency of immunological, metabolic, or genetic markers for type 1 diabetes and have an increased risk of developing type 1 diabetes. Diabetes Care 24:1210 -1216, 2001T ype 1 diabetes results from cellmediated autoimmune destruction of ␤-cells in the pancreas (1). Multiple genes contribute to the predisposition of the disease, and major histocompatibility complex (MHC) is the most important one (1). Moreover, evidence suggests that environmental factors, which are still poorly defined, may play a role in either precipitating the disease and/or dominantly shaping its course (1). Various autoantibodies against ␤-cell components are present in the serum of newly diagnosed patients with type 1 diabetes (1). More importantly, these circulating autoantibodies may be present for months to years preceding the onset of clinical diabetes (2). The rate of ␤-cell destruction is quite variable, as it is rapid in some individuals and slow in others (3). Some patients, particularly children and adolescents, may present with ketoacidosis at the first manifestation of the disease (4). Others have modest fasting hyperglycemia that can rapidly change to severe hyperglycemia and/or ketoacidosis in the presence of infection ...

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“…mg/dl has been reported to occur in 3-5% of the kids in the emergency room when compared with survivors, non survivors have high Blood glucose concentrates and they tend to have been exposed to longer duration of stress hyperglycemia. 5,6 A unique feature of critical illness is disturbed glucose homeostasis. Hence normalizing the physiological disturbance might hasten recovery.…”

Section: Introductionmentioning

confidence: 99%

Stress hyperglycemia: clinical profile and outcome in critically ill children

Grace¹,

Varadarajan

2017

Int J Contemp Pediatr

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INTRODUCTIONStress hyperglycemia(SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. [1][2][3][4] It is often discovered incidentally when routine blood sugar measurements reveal an elevated blood glucose. It is estimated that 49-70% of children with stress hyperglycemia have BG concentrates >150 mg/dl, 20-35% of children have BG > 200 mg/dl. 1-4However the occurrence of blood glucose more than 150 ABSTRACT Background: Stress hyperglycemia (SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. Objective of present study was to study the clinical presentation, underlying illness and the outcome of stress hyperglycemia among critically ill children. Methods: Children attending the outpatient department and the casualty were admitted to Emergency department based on the triage guidelines. Children with blood glucose above 200 mg/dl on admission to the emergency department were considered to have hyperglycemia and were shifted to the Paediatric intensive care unit or the paediatric wards for further management. Data was collected as per the proforma. The blood sugar values were followed up in these children until restoration of normoglycemia. All the children were followed up till discharge or death in case of mortality. Associated risk factors were analysed between the survivors and nonsurvivors. Results: Among 102 children included in the study group from1 month to 12 yrs, 55 were infants, 37 in the age group of 1-5 yrs and 10 were more than 5 yrs. 60 were males and 42 were females. Family history of diabetes was encountered in 10 children. Out of 102 children, 60 recovered to hospital discharge. Sepsis, seizures, bronchopneumonia and CNS infections were the common illness among children with stress hyperglycemia. Age less than 1year, breathlessness, fever, shock, seizures and altered sensorium were identified to be significantly associated with mortality in children with stress hyperglycemia by univariate analysis in this study. Regression analysis revealed age less than one year, presence of lung infiltrates, longer duration of hyperglycemia, and need for Paediatric Intensive Care Unit (PICU) admission to be significantly associated with mortality. Non survivors had persistent hyperglycemia up to 48 hours in comparison to survivors. Overall mortality in the study group was 41%. Conclusions: Incidence of stress hyperglycemia is high in infants. Infections were the common underlying diagnosis in stress hyperglycemia. Being an infant, prolonged hyperglycemia for 48 hrs and need for PICU care were significantly associated with mortality. Overall mortality in children with stress hyperglycemia is 41%.

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Prevalence of stress hyperglycemia among patients attending a pediatric emergency department

Cited by 50 publications

References 19 publications

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

Risk of Type 1 Diabetes Development in Children With Incidental Hyperglycemia

Stress hyperglycemia: clinical profile and outcome in critically ill children

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