Hyperglycemia during childhood diarrhea.
Level 4 - case-series / case-control
Case-control study comparing physiological and hormonal markers between hyperglycemic cases and normoglycemic controls.
PubMed 9003850 · doi:10.1016/s0022-3476(97)70309-3
What was done
During an 8-month period at a diarrhea treatment center in Bangladesh, blood glucose concentrations were determined for admitted children aged 2 to 10 years. Sixteen patients with hyperglycemia (blood glucose >10.0 mmol/L) and 20 age-matched controls with normal blood glucose (3.3 to 9.0 mmol/L) had blood samples drawn at admission, 4 hours, and 24 hours later to measure glucoregulatory hormones (epinephrine, norepinephrine, cortisol, glucagon, C-peptide) and gluconeogenic substrates.
What was found
The prevalence of hyperglycemia among admitted patients aged 2 to 10 years was 9.4%. Compared with normoglycemic controls, hyperglycemic patients had significantly higher rates of severe dehydration (100% vs. 10%, p < 0.001) and infection with Vibrio cholerae O1 or toxigenic Escherichia coli (94% vs. 25%, p < 0.001), with similar fasting durations (16 vs. 14 hours, p = 0.677). Hyperglycemic patients demonstrated significantly higher levels of epinephrine (7.15 vs. 2.00 micromol/L), norepinephrine (10.35 vs. 3.50 micromol/L), cortisol (1.38 vs. 0.82 micromol/L), glucagon (36 vs. 14 pmol/L), and C-peptide (1.22 vs. 0.35 nmol/L) (all p <= 0.014).
Why it matters
This study demonstrates that acute hyperglycemia during childhood diarrhea reflects a severe stress response to hypovolemia rather than fasting duration or primary insulin deficiency.
Limits
The sample size was small (16 cases and 20 controls) and recruited from a single treatment center. Follow-up substrate values at 4 and 24 hours and clinical outcomes following rehydration are not provided in the abstract.
Cited by
- partial Infection-induced cortisol elevation typically raises blood sugar to 120-130 mg/dL for three to fifteen days.