Abnormalities in Glucose Homeostasis in Critically Ill Children

Objectives: To study the prevalence of hyperglycemia (blood glucose > 126 mg/dL [> 7 mmol/L]) in critically ill children older than 1 month in the first week of PICU stay and to determine its effect on mortality, organ dysfunction, and the length of PICU stay. We also determined the prevalence of glucose variability and hypoglycemia and studied their effect on mortality and morbidity. Design: Prospective, observational cohort study. Setting: PICU of a tertiary care hospital. Patients: Children admitted to the PICU older than 1 month of age (January 2009 to June 2010). Interventions: None. Measurements and Main Results: Blood glucose values, clinical and laboratory data to calculate Pediatric Index of Mortality-2 and Pediatric Logistic Organ Dysfunction scores, caloric and carbohydrate intake, vasoactive drugs, and steroid and insulin usage for upto 7 days were recorded. Out of 170 critically ill children admitted to the PICU, hyperglycemia (blood glucose > 126 mg/dL [7 mmol/L]) was observed in 78.24% children (95% confidence interval 72-84.4). On adjusted analysis, blood glucose level > 180 mg/dL (10 mmol/L) was associated with increased mortality. Blood glucose > 126 mg/dL (7 mmol/L) was not associated with mortality or PICU length of stay but was associated with multiple organ dysfunction. Hypoglycemia and glucose variability also occurred frequently in critically ill children; these were associated with occurrence of multiple organ failure. Conclusions: Hyperglycemia (blood glucose > 126 mg/dL [7 mmol/L]) is common in critically ill children, and values > 180 mg/dL (10 mmol/L) are associated with mortality. We also noted that hyperglycemia, hypoglycemia (blood glucose <40 mg/dL [2.2 mmol/L]), and glucose variability were associated with multiple organ dysfunction. (Pediatr Crit Care Med 2013; 14:e16-e25)