Prevalence, presentation and immediate outcome of critically ill children with hypoglycemia presenting to the Acute Care Unit of Mulago Hospital

Abstract

Background: Hypoglycemia has been described as a common complication among critically ill children presenting to emergency paediatric units. It is associated with prolonged hospital stay and increased risk of mortality. In Uganda there is limited data on the magnitude hypoglycemia, its clinical presentation and the outcomes of critically ill children with hypoglycemia.

Objective: To determine the prevalence, describe the clinical presentation and immediate outcome of critically ill children with hypoglycemia presenting to the acute care unit (ACU) of Mulago hospital.

Methods: The study employed two study designs; a cross sectional descriptive design and a longitudinal observational design. Four hundred and fifty seven critically ill children aged 2 months -12 years presenting to the ACU of Mulago hospital were enrolled into the study. A random blood sugar, history and physical examination, blood slide for malaria parasites and a complete blood count were done. All participants were followed up for seven days to observe immediate outcomes that included death, discharge or still on ward by the last day of follow up.

Results: Four hundred and fifty seven participants were studied, the median age was 15 months (Range 2-144) and the male to female ratio was 1.2:1. Hypoglycemia was present in 27 out the 457 participants 5.9% (95% CI 3.7-8.1). The clinical features which were associated with hypoglycemia were inability to breastfeed or drink, difficulty in breathing, last meal ≥ 12 hours, prostration, prolonged capillary refill > 4 seconds and leucocytosis ≥ 11000 cells /µl. Among 27 hypoglycemic participants 9 (33.3%) died while only 16 out of the 423 participants with out hypoglycemia died (3.8%). Both hypoglycemic and none hypoglycemic participants who survived had comparable duration of hospital stay with in seven days of follow up.

Conclusions: Hypoglycemia is a common problem affecting about 1 in 20 critically ill children aged 2 months to 12 years presenting to the acute care unit of Mulago hospital. The clinical features associated with hypoglycemia included inability to breastfeed or drink, difficulty in breathing, last meal ≥ 12 hours, prostration, capillary refill time > 3 seconds and leucocytosis ≥ 11000 cells /µl The mortality rate with in seven days of follow up among participants with hypoglycemia was very high (33.3%) and majority died in the first 24 hours of admission.

Recommendations: Hypoglycaemia should be suspected among critically ill children with inability to breastfeed or drink, difficulty in breathing, last meal ≥ 12 hours, prostration and prolonged capillary refill > 4 seconds. Glucose testing facilities and 10% dextrose should be availed in paediatric emergency units so that hypoglycemic critically ill children who need therapeutic intervention can be identified and treated.