High prevalence of stress hyperglycaemia in children with febrile seizuresand traumatic injuries

Although hyperglycaemia is relatively frequent in the course of severe illn esses and may be looked upon as the possible result of an uncoordinated ins ulin response to the increased glucose that the body may need during period s of stress, it is generally agreed that it does not constitute a prediabet ic condition. Numerous studies have aimed to explain the pathophysiology of this occurrence but none has looked at which conditions are more prone to develop stress hyperglycaemia (SH). Therefore, the aim of this study was to evaluate the main clinical conditions that may be associated with SH in ch ildren. A total of 1199 children was studied: 833 children (439 M, 394 F, m ean age 5.2 +/- 4.5 y) admitted for an acute illness or injury constituted the stress-exposed group, while 366 children (222 M, 144F, mean age 6.2 +/- 4.6 y) admitted for elective minor surgery represented the stress-unexpose d group and were considered as the control group. SH was defined as plasma glucose concentrations greater than or equal to8.3 mmol l(-1) during an acu te illness, Stress-exposed patients had significantly higher glycaemic leve ls than controls (5.611.4 vs 4.7 +/- 0.7 mmol L-1 p < 0.0001). SH was found in 41 (4.9%) stress-exposed patients and in none of the controls. SH was s ignificantly more prevalent in children affected by febrile seizures (12.9% ) or traumatic injuries (11.7%; p < 0.008 and p < 0.02, respectively, vs ot her diagnoses). A significant correlation was found between glycaemia and s ystolic pressure (r=0.1; p < 0.01), white cell count (r = 0.12: p < 0.0003) and body temperature (r = 0.16; p < 0.0001). SH was more frequent in patie nts with body temperature > 39 degreesC (4.4%) than in those with a tempera ture less than or equal to 39 degreesC (4%: p < 0.0008). SH was more preval ent in clinical conditions of fever associated with seizures or pain (12.9% and 12.5%, respectively) than fever alone (4.4%). After a mean period of 3 .5 +/- 0.6 y of follow-up none of the hyperglycaemic patients had developed diabetes mellitus. Conclusion: Traumatic injuries, febrile seizures or conditions in which an elevated body temperature may be found are frequently associated with SH in children. In the presence of these conditions specific studies directed to wards unmasking a prediabetic state may be unnecessary.