Blood ketone levels in acute paediatric non-diabetic dysglycaemia and associated clinical outcomes

Abstract

Background: Children with acute illness are prone to energy dysregulation, marked biochemically as dysglycaemia with or without elevated blood ketone levels. Dysglycaemia has been linked to poor clinical outcomes without recourse to the ketone level. Objectives - To determine blood ketone levels among children with Dysglycemia and the association between ketone levels and Clinical outcome. Methodology: It was a cross-sectional study carried out at the Emergency Paediatric Unit of the University of Maiduguri Teaching Hospital among Children aged 1 month to 15 years. Children with dysglycaemia were tested for blood ketone levels. Data was analysed using SPSS Version 25. Results: Of the 340 subjects, 135 (39.7%) had dysglycaemia, out of which 81 (23.8%) were hyperglycaemic and 54 (15.9%) hypoglycaemic. Fifty-eight (43.0%) of those with dysglycaemia had elevated blood ketone, consisting of 12 (20.7%) in the hyperglycaemic group and 46 (79.3%) in the hypoglycaemic group. Age < 5 years {OR = 34.455 (2.147-550.458), p=0.012}, duration since last meal ≥ 24 hours {OR= 142.92(3.094-6589.604), P=0.011}, severe sepsis {OR=151.26(9.184-2495.760), P= <0.001} and hypoglycaemia, {OR= 50.529 (12.968-196.457) and P = < 0.001 were all independent predictors of elevated blood ketone
level. Dysglycaemic subjects with Elevated blood ketone were approximately 3 times more likely to die than those with normal blood ketone {UOR=3.4 (0.983-11.583) and P=0.043}. Conclusion: There was a high prevalence of dysglycaemia among acutely ill children. Elevated blood ketone levels among this cohort were associated with a bad outcome. We recommend routine determination of blood ketone level in children identified with dysglycaemia for closer monitoring and prognostication