Conference abstract

Hypoglycemia at presentation and mortality in a pediatric intensive care unit, Koutiala, Mali

Pan African Medical Journal - Conference Proceedings. 2018:9(4).08 Dec 2018.
doi: 10.11604/pamj-cp.2018.9.4.730

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Keywords: Shock, hypoglycemia, mortality

Hypoglycemia at presentation and mortality in a pediatric intensive care unit, Koutiala, Mali

Matthew Coldiron1,&, Joseph Sagara2, Christopher Mambula3, Lisa Umphrey4, Myrto Schaefer4, Rebecca F. Grais1

1Epicentre, Paris, France, 2Médecins Sans Frontières, OCP, Koutiala, Mali, 3Médecins Sans Frontières, OCP, France, 4Médecins Sans Frontières, OCP, Sydney, Australia

&Corresponding author
Matthew Coldiron, Epicentre, Paris, France


Introduction: international guidelines for critical care in low-resource environments often assume little or no diagnostic capability, which is not always the case in MSF field settings and presents an area for potential improvement in the quality of care. In a busy pediatric ICU supported by MSF in Koutiala, Mali, we describe hypoglycemia upon admission and its associations with negative outcomes. This is important, because measuring glycemia and correcting hypoglycemia are both simple interventions with important implications for mortality.

Methods: patient-level data were collected prospectively on all children admitted to the resuscitation room and the pediatric and nutritional ICUs for one year beginning in July 2015. Clinical and laboratory information was collected from charts during the first 24 hours of ICU care. All children were followed until hospital discharge. Data were anonymized and described. Risk ratios were calculated using log-binomial regression.

Results: hypoglycemia was extremely prevalent in all services and particularly in children admitted to the resuscitation room. Across all services, after controlling for age, sex and time since onset of illness, the rate of in-hospital mortality was significantly higher in children presenting with profound hypoglycemia (RR 3.7, 95% CI 3.1 - 4.3, p < 0.001) and with any hypoglycemia (RR 3.3, 95% CI 2.8 - 3.9, p < 0.001) compared to normoglycemic children. Similar trends were seen when the analysis was limited to children whose principal diagnosis was malaria.

Conclusion: we present a series of somewhat intuitive data that have not been documented in other MSF settings. As a result of these results, standard treatment protocols have already changed in Koutiala because of the limited risk associated with sugar solutions, all children admitted to the ICU now receive dextrose-containing fluids on admission.