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Glucose metabolism in children during the first day after burn injury
C Childs1, D F Heath, R A Little
1NWIRC (MRC Trauma Group), University of Manchester, U.K.
Insights
Hyperglycemia (high blood glucose) is common in children after burn injuries, peaking within hours. This response appears independent of burn severity and other injuries, suggesting a unique metabolic adaptation in pediatric burn patients.
Area of Science:
- Biochemistry
- Pediatric Medicine
- Trauma Research
Background:
- Burn injuries in children can trigger significant metabolic changes.
- Understanding these metabolic shifts is crucial for effective clinical management and patient outcomes.
Purpose of the Study:
- To investigate the metabolic response, specifically blood glucose and related metabolites, in children during the first 24 hours following burn injury.
- To compare the metabolic profile of pediatric burn patients with other injury types and adult burn patients.
Main Methods:
- Measurement of plasma and blood metabolites, including glucose, lactate, non-esterified fatty acids, insulin, cortisol, epinephrine, and norepinephrine.
- Serial sampling over the first 24 hours post-burn injury in 31 children.
- Comparative analysis with data from children with other injuries and adult burn patients.
Main Results:
- Hyperglycemia (blood glucose 10-20 mmol/l) was observed in 14 children within 1-4 hours post-burn, followed by a decline.
- The glucose peak was generally independent of burn severity and not observed in other pediatric or adult injuries.
- Metabolite levels (lactate, NEFA, insulin, cortisol, epinephrine) in the initial 4 hours were similar to other adult injuries, except for lower lactate rise in children.
- Hyperglycemia showed a weak correlation with epinephrine levels, and insulin resistance likely developed early but was not solely dependent on epinephrine-cortisol synergy after 8 hours.
Conclusions:
- Pediatric burn injuries induce a distinct early hyperglycemia, not directly correlated with burn severity or stress hormones like epinephrine.
- Early insulin resistance is a probable factor in pediatric burn hyperglycemia.
- Further research is needed to elucidate the precise mechanisms driving this unique metabolic response in children.
Abstract:
Plasma and blood metabolites were measured in 31 children over the first day after burn injury. In 14 of them blood glucose peaked, rising within 1-4h to 10-20 mmol/l and then falling, by 4-8 h, to 5-10 mmol/l. Usually the peak value preceded treatment and the fall occurred during infusion of dextrose-saline. Peak incidence was independent of burn severity. There was no evidence of similar peaks in children or adults with other injuries, or in 8 adults with burn injuries; through high glucose levels have been reported in children with head injuries. Lactate, non-esterified fatty acids, insulin, cortisol, epinephrine and norepinephrine were also measured. Values in the first 4 h were similar to those reported in adults with other injuries, except for lactate, which rose less in the children. Unexpectedly, the hyperglycemia in the children with burns was poorly related to epinephrine concentration at all times to 24h. Insulin resistance probably developed within the first hour or two; but from 8 h did not seem to depend on synergism between epinephrine and cortisol.