Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation.

Study Objective: The purpose of this study was to determine the prevalence of hypoglycemia and describe the clinical variables associated with hypoglycemia in children receiving resuscitation care.
Methods: A cross-sectional study of consecutive children receiving resuscitation care in an emergency department was performed. Rapid glucose testing was prospectively established as one of the initial resuscitation steps, and clinical variables were obtained from a retrospective chart review. The setting was an urban children's hospital ED (Level II trauma center) with a census of 31, 000 per year and a 10% admission rate. The patient population consisted of children (birth to 20 years of age) receiving resuscitation care for altered consciousness, status epilepticus, respiratory failure, cardiac failure, and cardiopulmonary arrest.
Results: Over a 1-year period, 49 nontrauma-related children received resuscitation care. Nine (18%; 95% confidence interval 8.7 to 32.2) were hypoglycemic (glucose level </=40 mg/dL). The median time from ED presentation to rapid glucose testing was 11 minutes (range, 0 to 65 minutes). Four of the hypoglycemic children had septic shock. The mortality rate was significantly greater (P =.015) in the hypoglycemic children.
Conclusion: Because hypoglycemia occurs often in children requiring resuscitation and clinical signs are often unspecific, routine rapid assessment of serum glucose is recommended. To increase physician awareness, adding "S" (sugar) to the popular mnemonic A (airway), B (breathing), and C (circulation): ABC'S is recommended. [Losek JD. Hypoglycemia and the ABC'S (sugar) of pediatric resuscitation. Ann Emerg Med. January 2000;35:43-46.]