Treating hyperglycemia in the critically ill child: is there enough evidence?

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Banani Poddar1

  • 1Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. bananip@sgpgi.ac.in

Indian Pediatrics
|August 5, 2011
PubMed

Insights

Managing hyperglycemia in critically ill children is vital. A blood glucose target below 150 mg/dL, with adequate nutrition and staff training, can improve outcomes and prevent hypoglycemia.

Area of Science:

  • Pediatric critical care
  • Endocrinology
  • Clinical nutrition

Background:

  • Hyperglycemia is common in critically ill children and linked to adverse outcomes.
  • Previously considered adaptive, hyperglycemia is now recognized as detrimental.
  • Insulin therapy can correct hyperglycemia but risks hypoglycemia.

Purpose of the Study:

  • To review the management of hyperglycemia in critically ill pediatric patients.
  • To discuss the benefits and risks of insulin therapy for hyperglycemia.
  • To provide guidance on appropriate blood glucose targets and supportive care.

Main Methods:

  • Literature search of PubMed using terms related to hyperglycemia, blood glucose, insulin therapy, and critical illness.
  • Inclusion of randomized controlled trials, clinical trials, meta-analyses, and observational studies.
  • Focus on studies published within the last 10 years, including adult and pediatric populations.

Main Results:

  • Hyperglycemia in critically ill children is associated with poor outcomes.
  • Insulin infusion can improve outcomes but requires careful monitoring due to hypoglycemia risk.
  • A target blood glucose level of <150 mg/dL is considered appropriate.

Conclusions:

  • Close blood sugar monitoring and hyperglycemia correction are essential for critically ill children.
  • Maintaining a modest blood glucose target (<150 mg/dL) is recommended.
  • Adequate nutrition and trained nursing staff are crucial for preventing adverse effects like hypoglycemia.
Abstract

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