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Abstract Abnormal blood glucose concentration is the most common metabolic abnormality in childhood particularly in critically ill children. Children are particularly prone to develop hypoglycaemia in a wide variety of diseases. In resource poor countries, poor nutritional status, infectious diseases, delay in presentation to hospital, and the lack of diagnostic facilities may aggravate hypoglycaemia. Hyperglycemia in non-diabetic patients is common in critically ill children. It does not appear to be associated with a particular diagnostic category but is significantly associated with the severity of illness. Severe hyperglycemia may be associated with complications; this in turn could result in end-organ dysfunction. Hyperglycemia is prevalent in critically ill patients and is associated with poor outcomes, and tight glycemic control may improve morbidity and mortality rates in some settings. In critically ill patients, the mortality risk associated with hypoglycaemia increases linearly with progressive increases in severity of hypoglycaemia. Mortality risk in the hypoglycaemic range develops more steeply than in the hyperglycaemic range. Severe illness was defined as the following; prostration (inability to sit unsupported, or breast feed), or abnormally deep breathing (Kussmauls respiration).Hypoxia, an oxygen saturation <90% in air; tachypnoea, a respiratory rate of >40 per minute in children between 1 and 5 years, and >50 per minute in infants greater than 2 months old; and severe malnutrition, weight below 3rd centile. Severe anaemia was defined as a haemoglobin of <5gm/dl. In our study, more than 21% of critically ill children admitted to Pediatric Emergency Unit in Sohag University Hospital had an abnormal blood glucose concentration. Hyperglycaemia (15.4%) was more common than Hypoglycaemia (6%).In our study, the highest proportion of hypoglycemia was observed in children with malnutrition (22.2%), liver cell failure (16.7%), C.N.S diseases (16.7%), gastroenteritis (11.1%) and heart failure (11.1%).Multivariate analysis of clinical variables associated with hypoglycemia showed that last meal >12 hours ago, and tachypnea are independent indicators of hypoglycaemia. In our study the highest proportion of hyperglycemia was observed in children with chest infection (23.4%), renal failure (21.3%), haematological diseases (17%), and gastroenteritis (14.9%). On multivariate analysis, tachypnea, and hypoxia were associated with hyperglycemia. In our study, hypoglycemia (BG <60 mg/dL) was observed in patients with organ failure; 16.7% of patients with liver cell failure were hypoglycemic (P value: 0.001), and patients with heart failure, 11.1 % of them were hypoglycemic. And, hyperglycemia was observed in patients with renal failure; 21.3 % of patients with renal failure were hyperglycemic (P value =0.001). In our study abnormal blood glucose measurement did not affect neither total length of hospital stay, nor length of stay at PICU, nevertheless, PICU admission was found to be more in patients with abnormal blood glucose measurements (23.1%) compared to patients with normal blood glucose measurements (3.4%).(P value = 0.000). In our study, hypoglycemia was strongly associated with increased mortality, as (55.6%) of patients who were observed to have hypo- glycemia died. Also mortality was associated with hyperglycemia; (25.5%) of patients who were observed to have hyperglycemia died. Abnormal glucose concentrations are common in critically ill children. where facilities for blood glucose estimation exist, blood glucose should be measured in all children sick enough to warrant admission, particularly those severely ill or malnourished children and who bear the brunt of mortality. |