Hypoglycaemia at point of hospital admission of under-five children with acute diarrhoea: prevalence and risk factors

Abstract

Abstract Background: Hypoglycaemia is one of life-threatening immediate complications of acute diarrhoea among under-five children but its diagnosis may be overlooked because all the symptoms may be mimicked by severe dehydration.

Objective: To determine the prevalence of hypoglycaemia at the point of hospital admission of under-five children with acute
diarrhoea and identify some of the risk factors. Methods: At the point of hospital admission, venous blood sample was collected into an appropriate sample bottle (fluoride-oxalate bottle) from 201 under-five children with acute diarrhoea for blood glucose determination. The blood samples were analysed using the glucose-oxidase method. One of the authors administered a
questionnaire to each of the caregiver to obtain information on the socio-demographic characteristics and the clinical profile (e.g., presence or absence of vomiting, duration of acute diarrhoea, time of last meal of the patients, and administration of ORS at home. Hypoglycaemia was defined as blood glucose value below 2.6 mmol/L.

Results: At the point of hospital admission, 7.7% (14 of 183; CI = 3.7-11.7) under-five children with acute diarrhoea had hypoglycaemia (blood glucose < 2.6 mmol/L) but dropped to 4.9% (CI=2.9-6.9) when a cutoff point of < 2.2 mmol/ L was applied. The risk factors for hypoglycaemia were the presence of severe dehydration (p<0.001), hypernatraemia and acidosis
(p<0.001). The prevalence of hypoglycaemia was 7 times higher in children whose time of last meal was ≥ 8 hours compared with their counterparts whose time of last meal was < 8 hours. Mortality rate was significantly higher in children with acute diarrhoea and hypoglycaemia compared with their counterparts with normoglycaemia (p<0.01).

Conclusion: In acute diarrhea, hypoglycaemia is an important comorbidity among children aged below 36 months and the significant associated risk factors for hypoglycaemia are severe dehydration, hypernatraemia and acidosis. Under-five children presenting with acute diarrhoea and  hypoglycaemia at point of hospitalization are at a significantly greater risk of death.

Keywords: Acute diarrhoea, hypoglycaemia, hypernatraemia,