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[Metabolic changes in critically ill children]
P Ruiz Magro1, C Aparicio López, J López-Herce Cid
1Unidad de Cuidados Intensivos Pediátricos, Ha General Universitario Gregorio Marañón, Madrid.
Insights
Metabolic disturbances are common in critically ill children and indicate a higher risk of complications and mortality. Early detection and correction of these imbalances are crucial for improved outcomes.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Pediatric Endocrinology
Context:
- Critically ill children in Pediatric Intensive Care Units (PICUs) frequently experience metabolic disturbances.
- These imbalances can significantly impact patient outcomes and require careful monitoring.
Purpose:
- To determine the incidence of metabolic disturbances in critically ill children.
- To assess the relationship between these disturbances and illness severity, complications, mortality, and hospital stay.
Summary:
- Retrospective analysis of 360 children admitted to the PICU revealed high incidences of hyperglycemia (51.9%), hypocalcemia (24.5%), and hypomagnesemia (47.4%).
- Specific metabolic abnormalities correlated with conditions like shock, sepsis, and mortality.
- While some disturbances were linked to mortality, no correlation was found between initial metabolite levels and length of PICU stay.
Impact:
- Metabolic disturbances are frequent in critically ill children and serve as important prognostic markers.
- Regular monitoring and early correction of metabolic imbalances are vital for improving patient care and outcomes in the PICU.
Objective:
Our aim was to analyze the incidence of metabolic disturbances in critically ill children and to evaluate their correlation with severity of illness, complications, mortality and length of hospital stay.
Patients And Methods:
We retrospectively studied 360 children who were admitted into a Pediatric Intensive Care Unit (PICU) between January 1995 and May 1996. We analyzed age, sex, initial diagnosis, complications, length of hospital stay and initial and final concentrations of serum glucose, calcium, phosphorus, magnesium and alkaline phosphatase.
Results:
The incidence of different metabolic disturbances at admission to the PICU was: hyperglycemia 51.9%, hypoglycemia 1.9%, hypocalcemia 24.5%, hypercalcemia 5.8%, hyperphosphatemia 7.3%, hypophosphatemia 7.9%, hypomagnesemia 47.4% and hypermagnesemia 3%. Patients with shock had lower concentrations of calcium and higher phosphorus levels, while children with sepsis had lower magnesium concentrations. Patients who died had a higher incidence of hyperphosphatemia and higher values of serum glucose and magnesium at admission, while patients who survived had lower concentrations of calcium and higher incidence of hypomagnesemia. We did not find any correlation between the initial values for metabolites and length of stay in the PICU.
Conclusions:
Metabolic disturbances in critically ill children are frequent findings, correlate with important complications and can be prognostic markers. Thus, regular controls of different metabolites must be performed so we can precociously detect these disturbances and correct them.