Fasting Predisposes to Hypoglycemia in Surinamese Children with Severe Pneumonia, and Young Children are More at Risk

The objective of this study was to investigate glucose kinetics during controlled fasting in children with severe pneumonia. Plasma glucose concentration, endogenous glucose production and gluconeogenesis were measured in 12 Surinamese children (six young: 1-3 years, six older: 3-5 years) with severe pneumonia during a controlled 16 h fast using stable isotopes [6,6-H-2(2)]glucose and (H2O)-H-2 at a hospital-based research facility. On admission, the glucose concentrations were comparable in both groups: young children: 5.1 +/- 1.3 mmol/l, older children: 4.8 +/- 0.6 mmol/l, p = 0.685, with a decrease during the first 8 h of fasting in the young children only to 3.6 +/- 0.5, p = 0.04. Glucose production was comparable in both groups: young: 24.5 +/- 8.3, older: 24.9 +/- 5.9 mu mol/kg(center dot)min, p = 0.926. Between 8 and 16 h of fasting, the glucose concentration decreased comparably in both groups (young: - 0.9 +/- 0.7, p = 0.004; older: -1.0 +/- 0.4 mmol/l, p = 0.001), as did glucose production (young: -6.8 +/- 6.3, p = 0.003; older: -5.3 +/- 3.4 mu mol/kg(center dot)min, p = 0.001). Gluconeogenesis decreased in young children only: -5.0 +/- 7.4, p = 0.029. We conclude that fasting predisposes to hypoglycemia in children with severe pneumonia. Young children are more at risk than older children. Glucose production is an important determinant of the plasma glucose concentration in young children with pneumonia, indicating an inability to reduce glucose usage. Our results are largely in agreement with the literature on the adaptation of glucose metabolism in children with malaria, although there seem to be disease-specific differences in the regulation of gluconeogenesis