Hypoglycemia during diarrhea in childhood: prevalence, pathophysiology, and outcome

Article Abstract:

Diarrhea is the major cause of death in children between one and five years in many developing countries, but the reasons for its lethality are poorly understood. One complication of diarrhea is hypoglycemia (low blood sugar). To better understand hypoglycemia that is associated with diarrhea in children, 2,003 severely ill patients were studied. The subjects were between the ages of 2 and 15 years, and had been admitted to a treatment center in Bangladesh. Blood samples were obtained before intravenous treatment began, and at various intervals thereafter; stool samples were also taken. The results showed that 91 of the 2,003 children were hypoglycemic, and 39 of these patients (42.9 percent) died in the hospital. In the patients without hypoglycemia, 122 in-hospital death occurred (6.4 percent). Of the total population of patients who died, 39 (24.2 percent) were hypoglycemic. In general, hypoglycemic patients had an average age of 36 months, in contrast to those without hypoglycemia, who were an average of 13 months old. Approximately 65 percent of hypoglycemic patients had enteric pathogens (abnormal organisms in their digestive tracts). Closer study of 46 hypoglycemic patients revealed that their diarrhea had been of shorter duration (12 hours versus 72 hours for normoglycemic patients), and a longer time had elapsed since they had last eaten. Hypoglycemic patients had higher blood glucagon (the hormone responsible for elevating blood sugar levels), epinephrine, norepinephrine, and lactate. The results indicate that hypoglycemia in these cases was not due to a failure of the glucagon and epinephrine regulatory systems, but rather, to failure of gluconeogenesis (the synthesis of glucose by the body from its component molecules). It is likely that this was caused by malnutrition, and the importance of continued feeding of such children during treatment is emphasized. In addition, shigellosis (a type of bacterial infection) was often found in hypoglycemic patients. Treatment recommendations were also discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Diarrhea, malnutrition, euglycemia, and fuel for thought

Article Abstract:

Euglycemia is a term used to describe normal levels of circulating glucose, the substance that serves as fuel for the body's cells. Hypoglycemia (too little blood glucose) occurs when glucose is depleted faster than it is supplied to blood; children and infants are especially susceptible to hypoglycemia. Under conditions of fasting or illness, glucose appears at a much slower rate in the blood as a result of one set of physiological processes called glycogenolysis. Although glucose use in the body decreases under such circumstances, the central nervous system is still requires glucose. In the May 10, 1990 issue of The New England Journal of Medicine, the prevalence of hypoglycemia and incidence of death in children with acute diarrhea in Bangladesh were studied. Several metabolic causes of hypoglycemia were ruled out through comparisons of children with and without this disorder. The level of many substances in blood were not different enough in the two groups to explain why hypoglycemia developed in some children, but not in others. One possibility is a decrease in the availability of fatty acids as a result of acquired metabolic defects of these substances. Carnitine is an essential cofactor in some metabolic processes involving fatty acids; a lack of carnitine is associated with hypoglycemia and brain diseases. Although the development of hypoglycemia, brain disorders, and death in malnourished children is undoubtedly multifactorial, further studies should consider evaluating carnitine and fatty acid levels as part of their protocols. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Single-dose azithromycin for the treatment of cholera in adults

Article Abstract:

A study evaluated the equivalence in adults of single-dose azithromycin and single-dose ciprofloxacin, a regimen found to be effective in the treatment of severe cholera in adults. Results demonstrate that single-dose azithromycin was effective in the treatment of severe cholera in adults, but the lack of efficacy of ciprofloxacin might result from its diminished activity against Vibrio cholerae O1 strains.

Drug therapy, Cholera, Dosage and administration, Azithromycin, Ciprofloxacin, Disease/Disorder overview

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