Extreme stress hyperglycemia during acute illness in a pediatric emergency department.
OBJECTIVE
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.
Weiss
Scott L
SL
Medicine Critical Care Program, Department of Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA. jdfisher1@cox.net
Alexander
Jamin
J
Agus
Michael S D
MS
D000208:Acute Disease; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015994:Incidence; D015278:Intensive Care Units, Pediatric; D008297:Male; D012140:Respiratory Tract Diseases / Q000097:blood / Q000150:complications*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D001786:Blood Glucose
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