Pediatric hypo- and low- glycemia in low income countries - how can treatment be optimised?

Severely ill children with low blood glucose values in resource poor setting suffer a three to four-fold higher risk of mortality compared to children with normal blood glucose.

The World Health Organization’s recommended treatment with 5ml/kg bolus dextrose followed by dextrose containing maintenance fluid has not been shown to decrease mortality among those with intermediary low blood glucose values. Thus, explanations for this excess mortality, other than the actual lack of glucose, must be sought.

One possibility is that boluses increase the incidence of abnormal glucose values with post-bolus hyperglycemia followed by rebound hypoglycemia, i.e. glycemic variability, with an associated alternation in blood electrolytes that may affect the heart and contribute to fatal cardiac events. This has caused some guidelines to recommend the use of only 2 ml/kg bolus to treat hypoglycemia.

Sublingual administration has also been suggested as an option for hypoglycemia treatment and may serve as a first aid choice in the absence of intravenous access. However, clear evidence is lacking to support these guidelines.

This three-arm randomized controlled trial will compare the incidence of post admission glycemic variability and electrolytes derangements between severely ill children with low and hypo glycemia receiving standard treatment versus 2 ml/kg intravenous dextrose bolus versus sublingual sugar.