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.
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References
Katoh K, Nomura M, Iga A et al (2003) Comparison of gastric peristalsis inhibition by scopolamine butylbromide and glucagon: evaluation by electrogastrography and analysis of heart rate variability. J Gastroenterol 38:629–635
Picazo J (ed) (1979) Glucagon in gastroenterology. MTP Press Limited, Lancaster
Gerich JE, Schneider V, Dippe SE et al (1974) Characterization of the glucagon response to hypoglycemia in man. J Clin Endrocrinol Metab 38:77–82
Bradshaw A, Sims JA, Richards WO (2007) Non-invasive assessment of the effects of glucagon on the gastric slow wave. Am J Physiol-Gastrointest Liver Physiol 293:1029–1038
Dziedzic TS, Smith TP (2008) Glucagon-induced vasospasm of hepatic artery branches during visceral angiography. Cardiovasc Intervent Radiol 31:S30–S33
Chait PG, Shandling B, Richards HM et al (1997) Fecal incontinence in children: treatment with percutaneous cecostomy tube placement—a prospective study. Radiology 203:621–624
Connolly B, Krishnamurthy G, Amaral J (2010) Upper gastrointestinal access in children: techniques and outcomes. Tech Vasc Interv Radiol 13:222–228
Kaye RD, Towbin RB (2002) Imaging and intervention in the gastrointestinal tract in children. Gastroenterol Clin North Am 31:897–923
Lewis EC, Connolly B, Temple M et al (2008) Growth outcomes and complications after radiologic gastronomy in 120 children. Pediatr Radiol 38:963–970
Saringcarinkul A, Kotrawera K (2009) Plasma glucose level in elective surgical patients administered with 5% dextrose in 0.45% NaCl in comparison with those receiving lactated ringer’s solution. J Med Assoc Thai 92:1178–1183
Welborn LG, McGill WA, Hannallah RS et al (1986) Perioperative blood glucose concentration in pediatric outpatients. Anesthesiology 65:543–547
De Onis M, Onyango AW, Borghi E et al (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 85:660–667
WHO Multicentre Growth Reference Study Group (2009) WHO child growth standards: growth velocity based on weight, length and head circumference: methods and development. World Health Organization, Geneva. http://www.who.int/childgrowth/standards/velocity/tr3_velocity_report.pdf. Accessed 8 Jan 2014
Lexicomp Online TM, Hudson, Ohio: Lexi-Comp, Inc.; January 29, 2011 Available via http://online.lexi.com/crlsql/servlet/crlonline
Dipchand AI, Friedman JN, Bismilla Z et al (2010) The hospital for sick children handbook of pediatrics, 11th edn. Saunders Elsevier, Canada, p 632
Wintergerst KA, Buckingham B, Gandrud L et al (2006) Association of hypoglycemia, hyperglycemia, and glucose variability with morbidity and death in the pediatric intensive care unit. Pediatrics 118:173–179
(2013) Glucagon. Information for the physician: glucagon for injection. Drugs.com. http://www.drugs.com/pro/glucagon.html. Accessed 8 Jan 2014
Aun CST, Panesar NS (1990) Pediatric glucose homeostasis during anaesthesia. Br J Anaesth 64:413–418
Acknowledgements
We gratefully acknowledge the advice and direction provided by Dr. Sanjay Mahant in the completion of the study.
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Bernhard, N., McAlpine, K., Moineddin, R. et al. Variations in blood glucose levels following gastrostomy tube insertion in a paediatric population. Pediatr Radiol 44, 863–870 (2014). https://doi.org/10.1007/s00247-014-2891-6
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DOI: https://doi.org/10.1007/s00247-014-2891-6