Continuous Insulin infusion therapy for acute stress hyperglycaemia secondary to asthma exacerbation in a paediatric emergency setting

Background: Transient mild stress hyperglycaemia is a common clinical finding while severe hyperglycaemia in response to stress is unusual in children. The practice of strict glycaemia control using intravenous insulin therapy remains
controversial within paediatric critical care practitioners and considerable disparity exists between physician beliefs and actual practice habits regarding glycaemia control in their critically ill paediatric patients. Clinical Case: A case of a 5 year old girl without pre-existing diabetes presenting to a paediatric emergency with severe asthma exacerbation and hyperglycaemia is discussed. The patient was commenced on a strict glycaemia control through
the use of intravenous intensive insulin therapy. Insulin infusion therapy was safe and effective in the treatment of her persistent severe hyperglycaemia in response to acute stress. No serious adverse side effects of insulin therapy were noted. Conclusion: We recommend that intravenous insulin therapy may be used for initial treatment of severe stress hyperglycaemia in children presenting acutely unwell in an emergency setting.