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Marked stress hyperglycemia in a child
Insights
Severe stress hyperglycemia, a significant increase in blood glucose, was observed in a 16-month-old child experiencing respiratory distress. This condition, linked to elevated cortisol, reached unprecedented levels, highlighting a unique pediatric case.
Area of Science:
- Pediatric Endocrinology
- Critical Care Medicine
- Metabolic Disorders
Background:
- Stress hyperglycemia is a transient increase in blood glucose levels due to acute illness or injury.
- Elevated cortisol levels are known to contribute to hyperglycemia.
- Pediatric cases of severe stress hyperglycemia are less commonly reported.
Observation:
- A 16-month-old child presented with respiratory distress syndrome.
- The child experienced a rapid and severe fluctuation in serum glucose, from 74 mg/dl to 520 mg/dl within 24 hours.
- Plasma cortisol levels mirrored glucose variations, rising from 41 to 90 mcg/dl.
Findings:
- The patient developed severe stress hyperglycemia, with glucose levels exceeding 350 mg/dl, a previously unreported severity in pediatric or adult cases.
- No intravenous dextrose or exogenous insulin was administered.
- The hyperglycemia resolved spontaneously within 24 hours.
Implications:
- This case expands the understanding of the potential severity of stress hyperglycemia in young children.
- It underscores the critical role of stress hormones like cortisol in pediatric metabolic responses to critical illness.
- Further research into the mechanisms and management of severe stress hyperglycemia in pediatrics is warranted.
Abstract:
A 16-month-old child is presented who developed severe "stress hyperglycemia" with the onset of a respiratory distress syndrome. The serum glucose rose from 74 mg/dl to 520 mg/dl and returned to 52 mg/dl all within 24 h. These variations in serum glucose were paralleled by a similar marked increase in plasma cortisol concentration (from 41 to 90 to 36 micrograms/dl). The patient was receiving no iv dextrose and required no exogenous insulin. These data are consistent with a diagnosis of stress hyperglycemia. This report is unique in that, to our knowledge, stress hyperglycemia to levels greater than 350 mg/dl have not been previously reported in either adults or children.