Low Blood Glucose and Its Relation to Electrolyte Derangements and Metabolic Acidosis in Critically Ill Children in Malawi

Critically ill children with low blood glucose concentrations in low-income settings suffer a high risk of mortality independent of other signs of disease severity and despite administration of the currently recommended treatment of hypoglycemia. This study explores other pathways that may relate to the high mortality risk, namely electrolyte derangements, metabolic acidosis, and hyperketonemia. Children ages 1 month to 5 years old presenting with one or more WHO emergency signs were recruited upon arrival to the Pediatric Accident and Emergency Department at Queen Elizabeth Central Hospital in Malawi between November 2022 and June 2024. A total of 12 hypoglycemic (blood glucose <2.5 mmol/L), 36 low glycemic (blood glucose 2.5-4.9 mmol/L), and 201 normoglycemic (blood glucose 5.0-10.0 mmol/L) children were enrolled. Low glycemic children had increased odds of acidosis (adjusted odds ratio [aOR] = 5.84, 95% CI: 1.17-29.2 for moderate acidosis; aOR = 27.1, 95% CI: 6.08-120.9 for severe acidosis). Among children with acidosis, there were increased odds of hypokalemia (aOR = 24.5, 95% CI: 2.91-205.88), hyponatremia (aOR = 2.58, 95% CI: 1.33-4.99 for moderate acidosis; aOR = 3.62, 95% CI: 1.71-7.68 for severe acidosis), and hypernatremia (aOR = 9.42, 95% CI: 2.50-35.5 for severe acidosis). There were no increased odds of potassium or sodium derangements in those with low glucose concentrations. Low blood glucose concentrations were associated with metabolic acidosis, which in turn, was associated with hypokalemia and hyponatremia/hypernatremia. However, there was no direct association between low blood glucose and electrolyte derangements.