title: Variations in blood glucose levels following gastrostomy tube insertion in a paediatric population.
abstract: BACKGROUND
  Radiologic insertion of a gastrostomy or gastrojejunostomy tube is a common procedure in children. Glucagon is used to create gastric hypotonia, permitting gastric distension and facilitating percutaneous puncture. Glucagon can cause hyperglycaemia and potentially rebound hypoglycaemia. The safety of glucagon and incidence of hypoglycaemia has not been studied following gastrostomy or gastrojejunostomy tube insertion.
  
  
  OBJECTIVE
  To determine variations in blood glucose in children post gastrostomy or gastrojejunostomy tube insertion. Secondarily, to determine the frequency of hypoglycaemia and hyperglycaemia in children who did or did not receive glucagon.
  
  
  METHODS
  This is a retrospective observational study of 210 children undergoing percutaneous gastrostomy or gastrojejunostomy tube insertion over a 2-year period. We studied the children's clinical and laboratory parameters. Abnormal blood glucose levels were defined according to age-established norms. We used descriptive statistics and ANOVA.
  
  
  RESULTS
  We analysed 210 children with recorded blood glucose levels. More than 50% of the children were less than the third percentile for weight. In the glucagon group (n = 187) hyperglycaemia occurred in 82.3% and hypoglycaemia in 2.7% (n = 5). In the no glucagon group (n = 23), hyperglycaemia occurred in 43.5% and there were no cases of hypoglycaemia. The peak blood glucose occurred within 2 h, with normalization by 6 h post-procedure. Five children became hypoglycaemic, all received glucagon; 4/5 had weights <3rd percentile. Logistic regression analysis revealed no factors significantly associated with hypoglycaemia.
  
  
  CONCLUSIONS
  Greatest blood glucose variability occurs between 1 h and 3 h post-procedure. Hyperglycaemia is common and more severe with glucagon, and hypoglycaemia rarely occurs. These findings have assisted in developing clinical guidelines for post-percutaneous gastrostomy/gastrojejunostomy tube insertion.
authors.affiliation: Division of Paediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Nirit
authors.initials: N
authors.lastname: Bernhard
authors.forename: Kristen
authors.initials: K
authors.lastname: McAlpine
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005774:Gastrostomy; D005934:Glucagon / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology*; D007003:Hypoglycemia / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D005765:Gastrointestinal Agents; D005934:Glucagon