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Indian Pediatr 2011;48:
824 |
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Hyperglycemia in the PICU : Tread with Caution |
M Sanklecha
Consultant Pediatrician, Bombay Hospital Institute of
Medical Science, 9C, Sind Chambers, First Floor, Colaba,
Mumbai 400 005, India.
Email: [email protected]
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The article "Treating Hyperglycemia in the Critically Ill Child Is there
Enough Evidence?"[1] was indeed an eye opener. In our regular care of the
critically ill pediatric patient, we commonly encounter hyperglycemia
which is, many a times, self-limiting. This is especially true of the
immediate post-operative period following neurosurgery, gut surgery or
cardiac surgery. While we do not have precise data, our observations seem
to suggest that post-operative hyperglycemia is transient, self-limiting
and not necessarily indicative of a poor outcome. The author has reviewed
studies of adults with critical illnesses, severe sepsis, myocardial
infarction, stroke and trauma as well as children with critical illnesses,
bronchiolitis, meningococcal sepsis and septic shock. The entire review
contains only a single reference regarding children undergoing heart
surgery. Patients undergoing elective and even emergency surgery may have
much less multiorgan dysfunction, unlike the critically ill child. While
the author emphasizes that the risk of hypoglycemia is minimal, though
this may be true in PICU’s with tight monitoring of blood glucose, there
is a distinct risk of life threatening hypoglycemia in smaller and
peripheral set-ups with the use of insulin in the face of a spontaneously
and rapidly correcting blood glucose in certain patients. Trying to
achieve rigorous normoglycemia in this post-operative group of transient
hyperglycemia would seem unjustified. While the epilogue does seem to give
a more balanced approach, the tone of the actual article as well as the
key messages may send out a wrong message
Reference
1. Poddar B. Treating hyperglycemia in the critically ill child: Is
there enough evidence? Indian Pediatr. 2011;48:531-6.
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