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Bruns N, Große Lordemann A, Rasche T, Meyburg J, Krüger M, Wieg C, Gratopp A, Hoppenz M, Heitmann F, Hoppen T, Löffler G, Felderhoff-Müser U, Dohna-Schwake C. Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children - a case series. Ital J Pediatr 2020; 46:179. [PMID: 33261643 PMCID: PMC7709336 DOI: 10.1186/s13052-020-00939-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/21/2020] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Nora Bruns
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Anja Große Lordemann
- Emergency Department, Children's Hospital Hamburg-Altona, Bleickenallee 38, 22763, Hamburg, Germany
| | - Tobias Rasche
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Jochen Meyburg
- Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Marcus Krüger
- Department of Neonatology, Munich Clinic Campus Harlaching and Schwabing, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Christian Wieg
- Department of Neonatology and Pediatric Intensive Care, Klinikum Aschaffenburg, Am Hasenkopf, 63739, Aschaffenburg, Germany
| | - Alexander Gratopp
- Division of Pediatric Emergency and Intensive Care Medicine, Charité University Medical Center, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marc Hoppenz
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital, Amsterdamer Str. 59, 50735, Cologne, Germany
| | - Friedhelm Heitmann
- Department of Pediatrics, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Germany
| | - Thomas Hoppen
- Department of Pediatrics, Gemeinschaftsklinikum Mittelrhein, Koblenzer Str. 115-155, 56073, Koblenz, Germany
| | - Günther Löffler
- Department of Pediatric and Neonatal Intensive Care, University Hospital of Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Christian Dohna-Schwake
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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