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Hyperglycemia during childhood diarrhea
Insights
Childhood diarrhea can cause hyperglycemia due to a stress response to hypovolemia. This study found higher stress hormone levels in children with hyperglycemia and severe dehydration.
Area of Science:
- Pediatrics
- Endocrinology
- Infectious Diseases
Background:
- Hyperglycemia is a potential complication of childhood diarrhea.
- The underlying mechanisms of hyperglycemia in this context require elucidation.
Purpose of the Study:
- To investigate the cause of hyperglycemia in children experiencing diarrhea.
- To identify factors associated with hyperglycemia in pediatric patients with diarrhea.
Main Methods:
- Blood glucose levels were measured in children aged 2-10 years admitted with diarrhea.
- Samples were analyzed for glucoregulatory hormones and gluconeogenic substrates in hyperglycemic and normoglycemic groups.
- Patients were assessed for dehydration and specific infectious agents.
Main Results:
- Hyperglycemia (blood glucose >10.0 mmol/L) was observed in 9.4% of pediatric diarrhea patients.
- Hyperglycemic patients exhibited higher rates of severe dehydration and Vibrio cholerae/toxigenic E. coli infections.
- Significantly elevated levels of epinephrine, norepinephrine, cortisol, glucagon, and C-peptide were found in hyperglycemic children.
Conclusions:
- The stress response to hypovolemia is the primary cause of hyperglycemia in childhood diarrhea.
- Severe dehydration and specific bacterial infections contribute to the development of hyperglycemia.
Objective:
To determine the cause of hyperglycemia in childhood diarrhea.
Methods:
During an 8-month period, patients admitted to a diarrhea treatment center in Bangladesh had their blood glucose concentrations determined. Sixteen patients aged 2 to 10 years with hyperglycemia (blood glucose concentration >10.0 mmol/L) and 20 patients in the same age group with a normal blood glucose concentration (3.3 to 9.0 mmol/L) had blood samples obtained on admission and 4 and 24 hours later for determination of glucoregulatory hormones and gluconeogenic substrates.
Results:
Prevalence of hyperglycemia among patients aged 2 to 10 years was 9.4%. Compared with the normoglycemic patients, hyperglycemic patients more often had severe dehydration (100% versus 10%, p <0.001), infection with Vibrio cholerae 0 1 or toxigenic Escherichia coli (94% vs 25%, p <0.001), and had similar duration of fasting (16 vs 14 hours, p = 0.677). Concentrations of epinephrine (7.15 vs 2.00 micromol/L), norepinephrine (10.35 vs 3.50 micromol/L), cortisol (1.38 vs 0.82 micromol/L), glucagon (36 vs 14 pmol/L), and C-peptide (1.22 vs 0.35 nmol/L) were all significantly (p < or = 0.014) higher in patients with hyperglycemia than in normoglycemic patients.
Conclusions:
The development of hyperglycemia in diarrhea is caused by a stress response to hypovolemia.