Hyperglycaemia in infantile gastroenteritis

We read with interest the paper by Rabinowitz et al.' Our own impressions were at variance with his figures. To verify our views we analysed 33 cases of acute gastroenteritis treated within our hospital in the last six months. All patients admitted with acute gastroenteritis have urea and electrolytes determinations before treatment is started. In our laboratory, blood glucose estimation is performed routinely on all blood samples sent for urea and electrolytes measurement. Blood glucose concentration is measured by glucose oxidase method. The age range of our patients was between 1 and 22 months (mean 7-3 months). Twenty of these were below the 3rd centile of the Boston weight chart. One stool sample grew shigella but none of the others grew any pathogenic bacteria. The degree of dehydration was calculated from the weight of the child at admission, and weight when diarrhoea had stopped and the child was fully rehydrated. There was good correlation between this method and the clinical assessment of dehydration at admission. Twelve children had severe dehydration with more than 10% loss of body weight and the rest had mild to moderate dehydration. Eleven children had high urea (more than 6-6 mmol/l), 14 had low potassium (less than 3-8 mmol/l), 10 had low sodium (less than 133 mmol/l), and 24 had low bicarbonate (less than 22 mmol/l) concentrations, but none had a blood glucose value of more than 10 mmol/l. An occasional patient with high blood glucose concentration has been seen by all of us but we were sure that in our experience the incidence could not have been as high as 55%. All the clinical and biochemical parameters of our patients were quite similar to those reported by Rabinowitz et al. The differences between our and their experience and the similarities between their normal and hyperglycaemic children with acute gastroenteritis show that there must be some other factor(s) responsible for this phenomenon. More work needs to be done to find out whether it is the type of virus, the race of the patient, or over zealous use of oral rehydration powder that is responsible for this disparity.