Original Article

Pediatric Radiology

, Volume 44, Issue 7, pp 863-870

First online:

Variations in blood glucose levels following gastrostomy tube insertion in a paediatric population

  • Nirit BernhardAffiliated withDivision of Paediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children
  • , Kristen McAlpineAffiliated withImage Guided Therapy, The Hospital for Sick Children, Medical School, Queens University
  • , Rahim MoineddinAffiliated withDepartment of Family and Community Medicine, University of Toronto
  • , Bairbre L. ConnollyAffiliated withImage Guided Therapy, Department of Diagnostic Imaging, University of Toronto, The Hospital for Sick Children Email author 

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Abstract

Background

Radiologic insertion of a gastrostomy or gastrojejunostomy tube is a common procedure in children. Glucagon is used to create gastric hypotonia, permitting gastric distension and facilitating percutaneous puncture. Glucagon can cause hyperglycaemia and potentially rebound hypoglycaemia. The safety of glucagon and incidence of hypoglycaemia has not been studied following gastrostomy or gastrojejunostomy tube insertion.

Objective

To determine variations in blood glucose in children post gastrostomy or gastrojejunostomy tube insertion. Secondarily, to determine the frequency of hypoglycaemia and hyperglycaemia in children who did or did not receive glucagon.

Materials and methods

This is a retrospective observational study of 210 children undergoing percutaneous gastrostomy or gastrojejunostomy tube insertion over a 2-year period. We studied the children’s clinical and laboratory parameters. Abnormal blood glucose levels were defined according to age-established norms. We used descriptive statistics and ANOVA.

Results

We analysed 210 children with recorded blood glucose levels. More than 50% of the children were less than the third percentile for weight. In the glucagon group (n = 187) hyperglycaemia occurred in 82.3% and hypoglycaemia in 2.7% (n = 5). In the no glucagon group (n = 23), hyperglycaemia occurred in 43.5% and there were no cases of hypoglycaemia. The peak blood glucose occurred within 2 h, with normalization by 6 h post-procedure. Five children became hypoglycaemic, all received glucagon; 4/5 had weights <3rd percentile. Logistic regression analysis revealed no factors significantly associated with hypoglycaemia.

Conclusion

Greatest blood glucose variability occurs between 1 h and 3 h post-procedure. Hyperglycaemia is common and more severe with glucagon, and hypoglycaemia rarely occurs. These findings have assisted in developing clinical guidelines for post-percutaneous gastrostomy/gastrojejunostomy tube insertion.

Keywords

Hypoglycaemia Hyperglycaemia Glucagon Interventional radiology Gastrojejunostomy Gastrostomy Children