Background: Little is known of the metabolic and endocrine response in severe life threatening infections in children.

Objectives: To study the stress response in children with meningococcal septic shock (MSS).

Methods: Measurements every 8 hours (I-VI in the table) of plasma glucose, insulin, glucagon, thyroxine(T4), growth hormone (GH), insulin-like growth factor I (IGF-I), cortisol and free fatty acids (NEFA) were made for the first 48 hours in 7 children with MSS. Diagnosis of MSS was made using standard criteria. The severity of illness was assessed using the PRISM score.

Table 1
Full size table

Results: The median age was 35 (29-45) months and the median PRISM score was 6 (4-25). Mean values are given in the table.

Conclusions: Children with MSS mount stress responses which are different in magnitude and timing to other stress circumstances. The hormonal stress response is modified. Thus levels of cortisol are increased, with little change in plasma GH, IGF-I and T4 levels. The rate of lipolysis is increased despite hyperglycemia indicating beginning insulin resistance. Whether this increase in lipolysis is simply due to increased cortisol or whether other stress factors such as catecholamines and/or TNF play a substantial role in metabolic regulation needs to be elucidated in future studies which could lead to the development of new therapeutic strategies.

O.A.F. Bodamer is funded by Pharmacia