Reducing glucose infusion safely prevents hyperglycemia in post-surgical children

Background & aims

To investigate the effects of two different glucose infusions on glucose homeostasis and amino acid metabolism in post-surgical children.

Methods

This randomized crossover study evaluated glucose and amino acid metabolism in eight children (age 9.8 ± 1.9 months, weight 9.5 ± 1.1 kg) admitted to a pediatric intensive care unit in a tertiary university hospital after surgical correction for non-syndromal craniosynostosis. Patients were randomized to receive low (LG; 2.5 mg kg⁻¹ min⁻¹) and standard (SG; 5.0 mg kg⁻¹ min⁻¹) glucose infusion in a crossover setting. After a bolus (4 g kg⁻¹) of deuterium oxide, we conducted a primed, constant, 8 h tracer infusion with 6,6-²H₂]Glucose, 1-¹³C]Leucine, ring-²H₅]Phenylalanine and 3,3-²H₂]Tyrosine.

Results

SG resulted in hyperglycemia (defined as > 6.1 mmol L⁻¹), while during LG plasma glucose levels were normoglycemic (5.9 ± 0.6 vs. 7.5 ± 1.7 mmol L⁻¹; LG vs. SG respectively, p = 0.02). Hypoglycemia did not occur during LG infusion. Endogenous glucose production was not fully suppressed during the hyperglycemic state under SG and increased with reduced glucose infusion (2.6 ± 1.5 vs. 1.1 ± 1.4 mg kg⁻¹ min⁻¹; LG vs. SG; p = 0.05). Whole body protein balance derived from leucine and phenylalanine kinetics was slightly negative but not further affected with a decrease in glucose infusion.

Conclusions

The current recommended glucose infusion induces hyperglycemia in post-surgical children. A reduced glucose infusion safely reduced high glucose levels, while children were capable to sustain normoglycemia with increased endogenous glucose production. The reduced glucose infusion did not exacerbate the mild catabolic state in which the patients were.