Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children – a case series

• Main Authors: Nora Bruns, Anja Große Lordemann, Tobias Rasche, Jochen Meyburg, Marcus Krüger, Christian Wieg, Alexander Gratopp, Marc Hoppenz, Friedhelm Heitmann, Thomas Hoppen, Günther Löffler, Ursula Felderhoff-Müser, Christian Dohna-Schwake
• Format: Article
• Language: English
• Published: BMC 2020-12-01
• Series: Italian Journal of Pediatrics
• Subjects: Hyperglycemia; Iatrogenic; Pediatric; Treatment error; Parenteral feeding; Parenteral nutrition
• Online Access: https://doi.org/10.1186/s13052-020-00939-9

Abstract Background Iatrogenic severe hyperglycemia (ISH) caused by glucose-containing i.v. solution is a potentially fatal treatment error. The objective of this study was to investigate the causes, circumstances, course of disease, and complications of ISH > 300 mg/dl (16.7 mmol/l) in neonates and children. Methods We emailed a survey to 105 neonatal and pediatric intensive care units in Germany, Austria, and Switzerland, asking to retrospectively report cases of ISH. Results We received 11 reports about premature infants to children. Four patients (36%) had poor outcome: 2 died and 2 suffered persistent sequelae. The highest observed blood glucose was at median 983 mg/dl (54.6 mmol/l) (range 594–2240 mg/dl; 33.0–124.3 mmol/l) and median time to normoglycemia was 7 h (range 2–23). Blood glucose was higher and time to normoglycemia longer in patients with poor outcome. Invasive therapy was required in 73% (mechanical ventilation) and 50% (vasopressor therapy) of patients, respectively. Administration of insulin did not differ between outcome groups. Patients with poor outcome showed coma (100% vs. 40%) and seizures (75% vs. 29%) more frequently than those with good outcome. Conclusions ISH is a severe condition with high morbidity and mortality. Further research to amplify the understanding of this condition is needed, but focus should largely be held on its prevention.