HYPOGLYCAEMIA IN CHILDREN AGED ONE MONTH TO 10 YEARS ADMITTED TO CHILDREN’S EMERGENCY CENTRE, LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Hypoglycaemia occurs in many disease states common in the tropics and may contribute
significantly to morbidity and mortality. Facilities and skilled manpower required for
laboratory blood glucose measurement are not always available in our health facilities,
yet it is important to make an early diagnosis of hypoglycaemia in order to minimize
hypoglycaemia-related organ damage.
The study was carried out to determine the prevalence and clinical conditions associated
with hypoglycaemia. It also set out to determine the validity of results obtained by using
a visually interpreted blood glucose reagent strip (Betachek Visual®) and that interpreted
using a reflectance meter (Accuchek Active®).
Four hundred and thirty patients aged one month to ten years who satisfied the study
criteria were recruited consecutively from the Children’s Emergency Room of Lagos
University Teaching Hospital (LUTH). The patients’ demographic data, presenting
complaint(s) and other essential information were filled into a pre-designed study
proforma. At the point of admission, a drop of blood obtained by a finger prick was
applied to each of the two types of reagent strips according to the manufacturer’s
instructions and about 1.5mls of blood was withdrawn from a convenient peripheral vein
and put in a fluoride oxalate-containing bottle for laboratory analysis. Hypoglycaemia
was defined as whole blood glucose < 2.2mmol/L (by bedside meters) and plasma
glucose < 2.5mmol/L (by laboratory analysis). Data were analyzed using Microsoft Excel
8.0 and Statistical Package for the Social Sciences (SPSS) 17.
The overall mean age of the study subjects was 38.76 ± 38.20 months with a range of 1.5
to 120 months and a median of 24 months. More than half of the entire patient
population consisted of children aged between one and twenty-four months. Using the
laboratory based method, the mean blood glucose of all the study subjects was 5.19 ±
2.05mmol/L (range: 0.1-18.0mmol/L, median: 4.9 mmol/L). Twenty-four patients (5.6%)
were hypoglycaemic by the laboratory method, 17 (4.0%) by Accuchek Active® and 59
(13.7%) by Betachek Visual®. The predominant disease conditions in which
hypoglycaemia occurred were severe malaria, multi-systemic infections, gastroenteritis
and protein-energy malnutrition. Hypoglycaemia was significantly associated with
increased mortality (2 = 15.8, df =1, p< 0.05). There was a high correlation (r =0.84, p<
0.05) between Accuchek Active® results and laboratory values than was obtained with
Betachek Visual® (r = 0.48, p=0.000). The bedside glucose monitors were found to have
a high specificity and high predictive values of a negative test (99.8% and 98.1% for
Accuchek Active® and 89.4% and 97.8% for Betachek Visual® respectively) with
moderate sensitivity (66.7% for both equipment). However, the Accuchek Active®
monitor has a much higher predictive value of a positive test (94.1%) compared to the
Betachek Visual® (27.1%).
Hypoglycaemia complicates common childhood illnesses seen in the emergency room of
LUTH. It is also associated with significant mortality. Hypoglycaemia should be
suspected in severely ill children with severe malaria, multi-systemic infections,
gastroenteritis and protein-energy malnutrition. The bedside glucose monitors are useful
bedside tools for blood glucose measurement to enable prompt correction when
hypoglycaemia is discovered, hence are recommended for routine use.

HYPOGLYCAEMIA IN CHILDREN AGED ONE MONTH TO 10 YEARS ADMITTED TO CHILDREN’S EMERGENCY CENTRE, LAGOS UNIVERSITY TEACHING HOSPITAL