Neonatology
Quality Improvement/Patient Safety
Endocrinology
Critical Care
Vijay Srinivasan, MBBS MD
Attending Physician
Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Michael Agus, MD
Division Chief
Division of Medical Critical Care, Department of Pediatrics
Boston Children's Hospital
Boston, Massachusetts, United States
This pro-con debate will review the problem of hypoglycemia detection andmonitoring in critically ill children admitted to the pediatric intensive care unit with impact on neuro-cognition and other outcomes. There is not quite enough evidence for harm, but the data is mounting. While data from neonates is more convincing for harm from hypoglycemia, the evidence is not so clear in older critically ill children. Recent trials of tight glucose control in this population of critically ill children did not observe any convincing benefits from such a strategy, but all trials uniformly observed variable increase in hypoglycemia rates. More concerningly, many critically ill children may have hypoglycemia even in the absence of tight glucose control and detection is often difficult due to the inability to discern symptoms. However, it remains unclear if hypoglycemia is transient or sustained due to current intermittent sampling methods with implications for detection and impact on outcomes.
Presenter: Vijay Srinivasan, MBBS MD – Children's Hospital of Philadelphia
Presenter: Michael Agus, MD – Boston Children's Hospital
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