Hyperglycaemia
ICD-10 code: R73.9 DESCRIPTION Critical illness is a state of metabolic stress associated with elevated serum catecholamines and is often associated with the use of continuous feeding. Hence the target blood glucose is 4–10 mmol/L. Serum glucose > 10 mmol/L is common, occurring in up to 20% of critically ill children. Clinical significance Increased morbidity and mortality. Osmotic diure
ICD-10 code: R73.9
DESCRIPTION
Critical illness is a state of metabolic stress associated with elevated serum catecholamines and is often associated with the use of continuous feeding. Hence the target blood glucose is 4–10 mmol/L. Serum glucose > 10 mmol/L is common, occurring in up to 20% of critically ill children.
Clinical significance
- Increased morbidity and mortality.
- Osmotic diuresis – fluid and electrolyte abnormalities.
- Increased infections and sepsis.
- Poorer neurological outcomes.
Monitoring
- Routine blood glucose monitoring: 4 to 6 hourly.
- Urine dipstix to check for glycosuria.
- If the patient is requiring insulin then hourly monitoring until blood glucose < 10 mmol/L.
Management
- Tight glycaemic control (maintenance of blood glucose between 4.4– 6.1 mmol/L) is NOT recommended.
- Look for and treat any potential underlying cause, e.g. sepsis, pain, steroid treatment etc.
- If HGT is > 10 mmol/L for 2 consecutive readings (60 minutes apart) or for 1 reading in the presence of glycosuria, then give a stat dose of IV short acting insulin 0.05 units/kg
- Calculate glucose delivery. If glucose delivery > age-appropriate range, reduce glucose delivery to within normal range and monitor HGTs.
- If a second dose of IV insulin is required within a 4-hour period, then seek advice from a paediatric endocrinologist.
- Insulin infusions are not routinely recommended.
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 23: Paediatric Intensive Care, 23.6 Electrolyte Abnormalities, 23.6.7 Hyperglycaemia