Blood Sugar Levels In Starved In-patient Children Coming For Elective Surgery As Compared To Non-Starved In-patients At The Kenyatta National Hospital.

Abstract

A prospective study was carried out at Kenyatta National Hospital to determine the blood sugar levels in two groups of children - one starved and coming for surgery and the other group not starved. Both groups consisted of in-patient children ranging from half to ten years age. The aim of the study was to deter mine whether there was a statistical significance between the two groups and to determine the correlation between the length of fast and the blood glucose levels. The first group (starved children) consisted of one hundred and ten inpatients of which males were seventy five i.e. 68.3% and females were thirty five i.e. 31.7%. The average age of the children in this group was 5.9 ~2.9 years and ranged from six months to ten years. These patients were all starved from the last hospital meal, at around 6 p.m. in the evening. except for a few very small children who were fed at around midnight. The mean length of fast in this group was 16.7 =.....3.0 hours and ranged from 9.7 to 22.8 hours. Premedication was the same for all patients in this group being Atropine O.Olmg/kg body weight and pethidine 1.0 - 1.5 mg /kg body weight. The blood samples were taken immediately after an inhalation induction with nitrous oxide (67%) oxygen (33%) and halothane (0-3%) before intubation or any surgical stimulus. The mean blood glucose level in this group was 3.3:!:. 0.35 mrnol/I and ranged from 2.4 - 4.4 mrnol/L The second group (non starved) was the control group and consisted of inpatients who were for surgery, but not on the day of sampling and had hence had their morning breakfast - at approximately 6 a.m This group consisted of eighty five patients of which males were 50 (58.8~,) and fe males were 3 5( 41.2 %) The average age was 7.6 years and ranged from 2.3 to 10 years. The mean length of fast was 1.8 ~ 1.1 hours and ranged from 0.3 to 3.8 hours. The samples were taken from willing patients and the average blood sugar level was 5.2 ~ 0.5 mmolll and ranged from 3.6 to 6.3 mmolll. It was found that none of the patients in either group was hypoglycemic. although some of the children in the study group had very low blood sugar levels. One patient was discovered to be an undiagnosed diabetic with a fasting . blood sugar of 20.8 mmolll which was reconfirmed. This patient was not included in the study and the information conveyed to the relevant ward. The study showed that 38.2% of the patients in the study group had a value corresponding to the mean sugar level vaule, whereas in the control group. it was 1().O% of the patients with the mean value. The study also showed that as whereas 37 (33.7% of the patients in the first group had blood sugar levels of less than 3.3 mmolll no patients in the second group had a blood sugar level of less than 3.6 mmol/I. Out of the 37 children in the first group, 28 (25.Y~) were males and the remaining 9 (8.2%) females. It was also Found that .3 (2.7% I of the patients had a blood sugar level of less than 2.8 mmolll out of which 2 ( 18 % I were mall and 1 (0.99%) was a female. The difference between the mean glucose levels of both groups was found to be statistically significant (P< 0.01 ) and that there was no correlation between the length of the fast and the blood sugar level. Hypoglycemia in this study, as well as in others was definded as a blood sugar level of less than 2.2 mmolll (40 mg/ dl), It is recommended that patients should not be given a feed for 6 hours preoperatively and clear liquids for 4 hours pre-operatively and that intravenous fluids should be continued post-operatively to correct fluid deficits till the patient is fully awake and feeding orally.