الفهرس 
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Abstract
Abnormal blood glucose concentration is the most common
metabolic abnormality in childhood particularly in critically ill children.
Children are particularly prone to develop hypoglycaemia in a wide
variety of diseases. In resource poor countries, poor nutritional
status, infectious diseases, delay in presentation to hospital, and the lack
of diagnostic facilities may aggravate hypoglycaemia.
Hyperglycemia in non-diabetic patients is common in critically ill
children. It does not appear to be associated with a particular diagnostic
category but is significantly associated with the severity of illness.
Severe hyperglycemia may be associated with complications; this in turn
could result in end-organ dysfunction. Hyperglycemia is prevalent in
critically ill patients and is associated with poor outcomes, and tight
glycemic control may improve morbidity and mortality rates in some
settings.
In critically ill patients, the mortality risk associated with
hypoglycaemia increases linearly with progressive increases in severity of
hypoglycaemia. Mortality risk in the hypoglycaemic range develops more
steeply than in the hyperglycaemic range.
Severe illness was defined as the following; prostration (inability to
sit unsupported, or breast feed), or abnormally deep breathing
(Kussmauls respiration).Hypoxia, an oxygen saturation <90% in air;
tachypnoea, a respiratory rate of >40 per minute in children between 1
and 5 years, and >50 per minute in infants greater than 2 months old; and
severe malnutrition, weight below 3rd centile. Severe anaemia was
defined as a haemoglobin of <5gm/dl.
In our study, more than 21% of critically ill children admitted to
Pediatric Emergency Unit in Sohag University Hospital had an abnormal
blood glucose concentration. Hyperglycaemia (15.4%) was more
common than Hypoglycaemia (6%).In our study, the highest proportion
of hypoglycemia was observed in children with malnutrition (22.2%),
liver cell failure (16.7%), C.N.S diseases (16.7%), gastroenteritis (11.1%)
and heart failure (11.1%).Multivariate analysis of clinical variables
associated with hypoglycemia showed that last meal >12 hours ago, and
tachypnea are independent indicators of hypoglycaemia.
In our study the highest proportion of hyperglycemia was observed
in children with chest infection (23.4%), renal failure (21.3%),
haematological diseases (17%), and gastroenteritis (14.9%). On
multivariate analysis, tachypnea, and hypoxia were associated with
hyperglycemia.
In our study, hypoglycemia (BG <60 mg/dL) was observed in
patients with organ failure; 16.7% of patients with liver cell failure were
hypoglycemic (P value: 0.001), and patients with heart failure, 11.1 % of
them were hypoglycemic. And, hyperglycemia was observed in patients
with renal failure; 21.3 % of patients with renal failure were
hyperglycemic (P value =0.001).
In our study abnormal blood glucose measurement did not affect
neither total length of hospital stay, nor length of stay at PICU,
nevertheless, PICU admission was found to be more in patients with
abnormal blood glucose measurements (23.1%) compared to patients
with normal blood glucose measurements (3.4%).(P value = 0.000).
In our study, hypoglycemia was strongly associated with increased
mortality, as (55.6%) of patients who were observed to have hypo-
glycemia died. Also mortality was associated with hyperglycemia;
(25.5%) of patients who were observed to have hyperglycemia died.
Abnormal glucose concentrations are common in critically ill
children. where facilities for blood glucose estimation exist, blood
glucose should be measured in all children sick enough to warrant
admission, particularly those severely ill or malnourished children and
who bear the brunt of mortality.