title: Hypoglycemia During the Temporary Interruption of Parenteral Nutrition Infusion in Pediatric Hematopoietic Stem Cell Transplantation.
abstract: Parenteral nutrition (PN) is required with pediatric procedures such as hematopoietic stem cell transplantation (HSCT). However, risks associated with temporary PN infusion interruption remain unclear.
  
  
  
  We retrospectively analyzed in 22 children undergoing HSCT receiving PN with the same daily routine: temporary PN infusion interruption before breakfast for administering a saline-diluted acyclovir drip. After correcting patients' glucose levels, we examined minimum blood glucose levels between preparative regimen initiation and post-HSCT day 30. Patients were divided into 2 groups according to a minimum glucose cutoff of 60 mg/dL. Patient background characteristics and hypoglycemia risk factors were compared between both groups.
  
  
  
  The hypoglycemia group had a significantly lower body surface area, higher glucose infusion rate (GIR), lower cholinesterase levels, and higher zinc levels at the onset of the minimum blood glucose level ( P < .05). Multivariate analyses revealed an association only between higher GIR (≥5 mg/kg/min) and hypoglycemia during the temporary PN infusion interruption. A time course analysis of blood glucose and immunoreactive insulin (IRI) levels in 1 patient revealed a combined high-caloric and saline flush before acyclovir initiation, causing temporary increased IRI, as the etiology for hypoglycemia.
  
  
  
  Particular attention and several precautions are required to prevent complications associated with temporary PN infusion interruption in children with higher GIR.
authors.affiliation: 1 Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan.|2 Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Ryu
authors.initials: R
authors.lastname: Yanagisawa
authors.affiliation: 3 Department of General Pediatrics, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: 1 Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan.|2 Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Komori
authors.affiliation: 1 Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Fujihara
authors.affiliation: 2 Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Hidaka
authors.affiliation: 2 Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morita
authors.affiliation: 4 Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Futatsugi
authors.affiliation: 4 Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Ono
authors.affiliation: 4 Department of Laboratory Medicine, Nagano Children's Hospital, Azumino, Japan.|5 Life Science Research Center, Nagano Children's Hospital, Azumino, Japan.
authors.forename: Eiko
authors.initials: E
authors.lastname: Hidaka
authors.affiliation: 1 Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan.|2 Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Sakashita
authors.affiliation: 6 Department of Pediatrics, Matsumoto Dental University School of Dentistry, Shiojiri, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Shiohara
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000175:diagnosis*; D007223:Infant; D007262:Infusions, Intravenous / Q000009:adverse effects*; D007328:Insulin / Q000097:blood; D008297:Male; D009752:Nutritional Status; D010288:Parenteral Nutrition / Q000009:adverse effects*; D012177:Retinol-Binding Proteins / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D014168:Transferrin / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D007328:Insulin; D012177:Retinol-Binding Proteins; D012709:Serum Albumin; D014168:Transferrin; D002784:Cholesterol
keywords: glucose infusion rate; hypoglycemia; parenteral nutrition; pediatric nutrition; stem cell transplantation