Complications of H1N1 infection include severe pneumonia, empyema, ARDS,
seizures, encephalitis and myocarditis(1). We report a 11 year old female,
diagnosed to have H1N1 infection by RT-PCR, in whom a routine random blood
sugar showed hyperglycemia (240 mg/dL). Child had high fasting
(149,109,172 mg/dL) and postprandial blood sugar (258,160,192 mg/dL),
respectively on day 1, 2 and 3 of testing. However, 4th day onwards, for
three consecutive days, child had normal fasting and postprandial sugar.
HbA1C was normal (6.3%) suggesting this was a transient hyperglycemia.
Urine and serum ketones were negative on all 6 days. Urine Sugar was 1+
positive for the first 3 days when blood sugar was high and negative once
blood sugar normalized. Child was receiving oseltamivir only during the
illness.
It is thought that influenza causes an increase in IL-6
levels which may lead to increased cortisol levels, followed by a
pronounced dose-dependent increase in blood glucose. It is also postulated
that systemic hypercytokinemia in influenza causes hyperglycemia and that
the glucose levels reflect the degree of pathogenicity(2). Literature
search revealed hyperglycemia as a complication associated with higher
mortality in H5N1 cases(2) and in few critically ill children with
influenza encephalo-pathy(3). Another speculation was whether the
hyperglycemia was related to administration of oseltamivir, a complication
of this drug, hitherto undescribed. However, only rare aggravation of
pre-existing diabetes has been described with oseltamivir(4), and not
transient hyperglycemia.
References
1. Cunha BA. Pneumonia Essentials. 3rd ed. Sudbury
(MA): Jones and Bartlett; 2010.
2. Nagao T, Morishima T, Kimura H, Yokota S, Yamashita
N, Ichiyama T, et al. Prognostic factors in influenza associated
encephalopathy. Pediatr Infect Dis J 2008; 27: 384-389.
3. Wiwanitkit V. Hyperglycemia in the recent reported
cases of bird flu infection in Thailand and Vietnam. J Diab Complic 2008;
22: 76.
4. Roche Laboratories, Inc. Tamiflu product
information. Available from: http://www. gene.com/gene/products/information/tamiflu/pdf/pi.pdf.
Accessed on 29 March, 2010.