Prevalence of hypoglycemia in diarrheal dehydration at hospitalization in severe acute malnutrition


  • Rameshwar Ninama Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Chakshu Chaudhry Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Rameshwar Lal Suman Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Suresh Goyal Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Ramprakash Prakash Bairwa Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India
  • Sanjay Singla Department of Pediatrics, RNT Medical College, Udaipur, Rajasthan, India



Dehydration, Diarrhea, Hypoglycemia, Oral rehydration solution, Severe acute malnutrition


Background: Diarrhea is the major cause of death in children below five years of age. Hypoglycemia has been a potential fatal complication of infectious diarrhea in both well-nourished and poorly nourished children. But prevalence of hypoglycemia in diarrheal dehydration is not exactly known. This study was done to evaluate the glycemic status in children having acute diarrhea with dehydration and specifically associated with severe acute malnutrition (SAM).

Methods: This descriptive cross-sectional study was conducted during July 2017 to December 2017 at Bal Chikitsalaya Udaipur, Rajasthan, India. Blood glucose levels were assessed in 150 children of acute diarrhea with dehydration, comprising of 100 SAM and 50 Non SAM children.

Results: Average blood glucose of SAM children was 89 mg/dl and of non-SAM, it was 120 mg/dl. Average blood glucose was low in SAM as compared to non-SAM in both some dehydration (116.08±21.26) and severe dehydration (66.69±19.80) as well as with or without ORS intake. Overall 18 (12%) of children had hypoglycemia and all were in severe dehydration and not taking ORS. Blood glucose levels were statistically low in severe dehydration and those who were not taking ORS at the time of hospitalization (p = 0.001). In severe dehydration 25% of children had hypoglycemia means every fourth child had low blood glucose <54 mg/dl.

Conclusions: Overall prevalence of hypoglycemia is 12% in diarrheal dehydration and 20% in SAM with dehydration. Twenty five percent of severe dehydration children had hypoglycemia, and all have not started ORS. None of the child started ORS developed hypoglycaemia.


The burden of disease resulting from diarrhea. In: Division of health promotion and disease prevention, Division of International Health, Institute of Medicine. New vaccine development: establishing priorities. Vol. 2. Diseases of importance in developing countries. Washington, D.C.: National Academy Press; 1986:159-169.

Chen LC, Rahman M, Sardar AM. Epidemiology and causes of death among children in a rural area of Bangladesh. Int J Epidemiol. 1980;9:25-33.

Ronsmans C, Bennish ML, Wierzba T. Diagnosis and management of dysentery by community health worker. Lancet. 1988;2:552-5.

Hirschhorn N, Lindenbaum J, Greenough WB III, Alam SM. Hypoglycemia in children with acute diarrhea. Lancet. 1966;2:128-32.

Jones RG. Hypoglycemia in children with acute diarrhea. Lancet. 1966;2:643.

Molla AM, Hossain M, Islam R, Bardhan PK, Sarker SA. Hypoglycemia: a complication of diarrhea in childhood. Ind Pediatr. 1981;18:181-5.

Mathur GP, Kushwaha KP, Mathur S. Protein energy malutrition. In: Gupte S, eds. Recent advances in Pediatrics (special vol 6): Gastro enterology, hepatology, and nutrition. New Delhi: Jaypee Brothers; 2000:479-82.

Udani PM. Protein energy malnutrition, In: PM Udani (eds). Text Book of Pediatrics (revised 1st ed). New Delhi: Jaypee Brothers; 1998:476-55.

Seth A, Aneja S. Hyperglycemia in malnourished children with dehydrating gastro enteritis. Indian J Pediatr.1995;65:353-5.

Heggarty H, Trindade P, Bryan EM. Hyperglycemia in hyper osmolar dehydration. Arch Dis Childhood. 1973;48:740-1.

Mandell F, Fellers FX. Hperglycemia in hypernatremic dehydration. Clin Padiatr. 1974;13:367-9.

Rabinowitz L, Joffe BI, Abkiewicz C, Shires R, Greef MC, Seftel HC. Hyperglycemia in infantile gastro enteritis. Arch Dis Childhood. 1984;59:771-5

Stevenson RE, Bowyer FP. Hyperglycemia with hyper osmolar dehydration in non-diabetic infants J Pediatr. 1970;77:818-25.

Srivastava A, Jagadisan B, Yachha SK. Diseases of gastrointestinal system and Liver. In: Ghai OP, Paul VK, Bagga A, eds. Essential pediatrics. New Delhi: CBS Publishers; 2009:260-265.

WHO. WHO child growth standards and the identification of severe acute malnutrition in infants and children. a joint statement by WHO and UNICEF. 2009. Available at http// malnutrition/9789241598163-eng.pdf

American Association for Clinical Chemistry. Diabetes Mellitus. Available at Accessed 15th June, 2010

Bennish ML, Azad AK, Rahman O, Phillips RE. Hypoglycemia during diarrhea in childhood: prevalence, pathophysiology and outcome. New Engl J Med. 1990;322(19):1357-63.

Butler T, Arnold M, Islam M. Depletion of hepatic glycogen in the hypoglycaemia of childhood diarrheal illnesses. Trans Royal Soc Trop Med Hyg 1989;83(6):839-43.

Chandra S, Singh DK, Ansari MA, Pareek P. Blood glucose as a predictor of diarrheal dehydration in children. Indian J Child Health. 2016;3(3):261-2.

Ntia HN, Anah MU, Udo JJ, Ewa AU, Onubi J. Prevalence of hypoglycemia in under-five children presenting with acute diarrhea in University of Calabar Teaching Hospital, Calabar. Niger J Paediatr. 2012;39(2):63.






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