Iatrogenic severe hyperglycemia due to parenteral administration of glucose in children - a case series.
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.
['Bruns|Nora|N|http://orcid.org/0000-0003-3809-1887', 'Große Lordemann|Anja|A|', 'Rasche|Tobias|T|', 'Meyburg|Jochen|J|', 'Krüger|Marcus|M|', 'Wieg|Christian|C|', 'Gratopp|Alexander|A|', 'Hoppenz|Marc|M|', 'Heitmann|Friedhelm|F|', 'Hoppen|Thomas|T|', 'Löffler|Günther|G|', 'Felderhoff-Müser|Ursula|U|', 'Dohna-Schwake|Christian|C|']
D001786:Blood Glucose D005060:Europe D005260:Female D005947:Glucose D006801:Humans D006943:Hyperglycemia D007049:Iatrogenic Disease D007223:Infant D007231:Infant, Newborn D007263:Infusions, Parenteral D015278:Intensive Care Units, Pediatric D008297:Male D012121:Respiration, Artificial D012189:Retrospective Studies D013549:Sweetening Agents D014662:Vasoconstrictor Agents
Iatrogenic Hyperglycemia Administration Glucose Treatment error Pediatric Parenteral feeding Parenteral nutrition