Stress Hyperglycemia in Pediatric Critical Illness: the Intensive Care Unit Adds to the Stress!

Overview

Journal J Diabetes Sci Technol

Specialty Endocrinology

Date 2012 Mar 10

PMID 22401321

Citations 25

Authors

Vijay Srinivasan

Affiliations

Soon will be listed here.

Abstract

Stress hyperglycemia (SH) commonly occurs during critical illness in children. The historical view that SH is beneficial has been questioned in light of evidence that demonstrates the association of SH with worse outcomes. In addition to intrinsic changes in glucose metabolism and development of insulin resistance, specific intensive care unit (ICU) practices may influence the development of SH during critical illness. Mechanical ventilation, vasoactive infusions, renal replacement therapies, cardiopulmonary bypass and extracorporeal life support, therapeutic hypothermia, prolonged immobility, nutrition support practices, and the use of medications are all known to mediate development of SH in critical illness. Tight glucose control (TGC) to manage SH has emerged as a promising therapy to improve outcomes in critically ill adults, but results have been inconclusive. Large variations in ICU practices across studies likely resulted in inconsistent results. Future studies of TGC need to take into account the impact of commonly used ICU practices and, ideally, standardize protocols in an attempt to improve the accuracy of conclusions from such studies.

Citing Articles

The Interaction and Implication of Stress-Induced Hyperglycemia and Cytokine Release Following Traumatic Injury: A Structured Scoping Review.

Al-Hassani I, Khan N, Elmenyar E, Al-Hassani A, Rizoli S, Al-Thani H Diagnostics (Basel). 2024; 14(23).

PMID: 39682557 PMC: 11640098. DOI: 10.3390/diagnostics14232649.

Response to the Letter to the Editor entitled "Glucokinase maturity-onset diabetes of the young as a mimicker of stress hyperglycemia: a case report" by Amanda Doherty-Kirby, Clin Pediatr Endocrinol 2023;32:72-75.

Terashita S Clin Pediatr Endocrinol. 2023; 32(2):124.

PMID: 37020701 PMC: 10068623. DOI: 10.1297/cpe.2023-0001-2.

Glucose Metabolism and Stress Hyperglycemia in Critically Ill Children.

Srinivasan V Indian J Pediatr. 2023; 90(3):272-279.

PMID: 36645581 DOI: 10.1007/s12098-022-04439-y.

Postdischarge Glucocorticoid Use and Clinical Outcomes of Multisystem Inflammatory Syndrome in Children.

Son M, Berbert L, Young C, Dallas J, Newhams M, Chen S JAMA Netw Open. 2022; 5(11):e2241622.

PMID: 36367723 PMC: 9652757. DOI: 10.1001/jamanetworkopen.2022.41622.

Nutritional Support for Pediatric Severe Traumatic Brain Injury.

Elliott E, Shoykhet M, Bell M, Wai K Front Pediatr. 2022; 10:904654.

PMID: 35656382 PMC: 9152222. DOI: 10.3389/fped.2022.904654.

References

de Ferranti S, Gauvreau K, Hickey P, Jonas R, Wypij D, du Plessis A . Intraoperative hyperglycemia during infant cardiac surgery is not associated with adverse neurodevelopmental outcomes at 1, 4, and 8 years. Anesthesiology. 2004; 100(6):1345-52. DOI: 10.1097/00000542-200406000-00005. View

Nielsen N, Sunde K, Hovdenes J, Riker R, Rubertsson S, Stammet P . Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Crit Care Med. 2010; 39(1):57-64. DOI: 10.1097/CCM.0b013e3181fa4301. View

Brower R . Consequences of bed rest. Crit Care Med. 2010; 37(10 Suppl):S422-8. DOI: 10.1097/CCM.0b013e3181b6e30a. View

Vlasselaers D, Milants I, Desmet L, Wouters P, Vanhorebeek I, van den Heuvel I . Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009; 373(9663):547-56. DOI: 10.1016/S0140-6736(09)60044-1. View

Petrakis I, Kogerakis N, Prokopakis G, Zacharioudakis G, Antonakakis S, Vrachassotakis N . Hyperglycemia attenuates erythromycin-induced acceleration of liquid-phase gastric emptying of hypertonic liquids in healthy subjects. Dig Dis Sci. 2002; 47(1):67-72. DOI: 10.1023/a:1013211419605. View

Stevens R, Dowdy D, Michaels R, Mendez-Tellez P, Pronovost P, Needham D . Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med. 2007; 33(11):1876-91. DOI: 10.1007/s00134-007-0772-2. View

Zimmerman J . A history of adjunctive glucocorticoid treatment for pediatric sepsis: moving beyond steroid pulp fiction toward evidence-based medicine. Pediatr Crit Care Med. 2007; 8(6):530-9. DOI: 10.1097/01.PCC.0000288710.11834.E6. View

Wintergerst K, Buckingham B, Gandrud L, Wong B, Kache S, Wilson D . Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics. 2006; 118(1):173-9. DOI: 10.1542/peds.2005-1819. View

Coss-Bu J, Jefferson L, Walding D, David Y, Smith E, Klish W . Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values. Am J Clin Nutr. 1998; 67(1):74-80. DOI: 10.1093/ajcn/67.1.74. View

10.

Preissig C, Rigby M . A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits. Crit Care. 2010; 14(1):R11. PMC: 2875525. DOI: 10.1186/cc8865. View

11.

Rao A, Chouhan V, Chen X, Sun L, Boden G . Activation of the tissue factor pathway of blood coagulation during prolonged hyperglycemia in young healthy men. Diabetes. 1999; 48(5):1156-61. DOI: 10.2337/diabetes.48.5.1156. View

12.

Sheridan R, Yu Y, Prelack K, Young V, Burke J, Tompkins R . Maximal parenteral glucose oxidation in hypermetabolic young children: a stable isotope study. JPEN J Parenter Enteral Nutr. 1998; 22(4):212-6. DOI: 10.1177/0148607198022004212. View

13.

Chwals W . Overfeeding the critically ill child: fact or fantasy?. New Horiz. 1994; 2(2):147-55. View

14.

Jeevanandam M, Young D, Schiller W . Glucose turnover, oxidation, and indices of recycling in severely traumatized patients. J Trauma. 1990; 30(5):582-9. DOI: 10.1097/00005373-199005000-00010. View

15.

Gardelis J, Hatzis T, Stamogiannou L, Dona A, Fotinou A, Brestas P . Activity of the growth hormone/insulin-like growth factor-I axis in critically ill children. J Pediatr Endocrinol Metab. 2005; 18(4):363-72. DOI: 10.1515/jpem.2005.18.4.363. View

16.

Aljada A, Friedman J, Ghanim H, Mohanty P, Hofmeyer D, Chaudhuri A . Glucose ingestion induces an increase in intranuclear nuclear factor kappaB, a fall in cellular inhibitor kappaB, and an increase in tumor necrosis factor alpha messenger RNA by mononuclear cells in healthy human subjects. Metabolism. 2006; 55(9):1177-85. DOI: 10.1016/j.metabol.2006.04.016. View

17.

Hennessey P, Black C, Andrassy R . Nonenzymatic glycosylation of immunoglobulin G impairs complement fixation. JPEN J Parenter Enteral Nutr. 1991; 15(1):60-4. DOI: 10.1177/014860719101500160. View

18.

Michaud L, Rivara F, Longstreth Jr W, Grady M . Elevated initial blood glucose levels and poor outcome following severe brain injuries in children. J Trauma. 1991; 31(10):1356-62. DOI: 10.1097/00005373-199110000-00007. View

19.

Ballweg J, Wernovsky G, Ittenbach R, Bernbaum J, Gerdes M, Gallagher P . Hyperglycemia after infant cardiac surgery does not adversely impact neurodevelopmental outcome. Ann Thorac Surg. 2007; 84(6):2052-8. DOI: 10.1016/j.athoracsur.2007.06.099. View

20.

Langouche L, Vanhorebeek I, Vlasselaers D, Vander Perre S, Wouters P, Skogstrand K . Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest. 2005; 115(8):2277-86. PMC: 1180545. DOI: 10.1172/JCI25385. View