Lower Glucose Values Research Articles

Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes

The recent demonstration (1–3) of the benefits of intensive glycemic control in hospitalized patients has renewed interest in inpatient management of diabetes. Poor glycemic control is a marker for poor quality of hospital care (4), as well as an important safety issue: insulin is one of five medications most associated with inpatient medication errors (5,6). Moreover, many hospitals continue to solely rely on insulin “sliding scales” despite the limitations of this approach (7,8). To gain a broader understanding of the current quality of inpatient diabetes management, we analyzed the prevalence and management of hyper- and hypoglycemia among 999 patients with known diabetes treated in 44 hospitals across the U.S. Data were derived from two sources: the University Health System Consortium (UHC) Diabetes Benchmarking Project and VHA, Inc. The UHC project collected inpatient and outpatient data in 2003 by standardized chart review of 274 patients aged ≥18 years with type 1 and type 2 diabetes (diagnosed by their outpatient physicians), who were admitted as inpatients to 1 of 29 academic medical centers located in 20 states. Chart reviewers identified the highest and lowest glucose values during hospital admissions and recorded the highest and lowest glucose results for the 2 days preceding and following the peak and nadir. In 2003–2004, 15 member hospitals of VHA, Inc, an alliance that serves ∼1,400 not-for-profit U.S. hospitals, performed baseline chart reviews on 725 general medical and surgical patients aged >18 …

The effects of telmisartan and amlodipine on metabolic parameters and blood pressure in type 2 diabetic, hypertensive patients

Hypertension in type 2 diabetes represents a strong risk factor for cardiovascular events. Either calcium channel blockers or angiotensin receptor blockers (ARBs) may reduce insulin resistance. One of the ARBs, telmisartan (Telm) acting as a PPARgamma agonist, significantly reduces HbA(1C) levels. The aim of this study was the comparison of the effects on glycaemic control of amlodipine (Aml) and Telm in hypertensive type 2 diabetic patients. Forty diabetic hypertensive subjects were assigned to two groups. Group A: rosiglitazone (RSG) 4 mg + Telm 80 mg; Group B: RSG 4 mg + Aml 10 mg. All the patients were already treated with metformin, but not with antihypertensive drugs. After four months treatment, both groups showed a significant reduction of mean blood pressure (Group A: - 13.5%; Group B: - 13.3%) and a positive influence on glycaemic control and insulin resistance. Lower values of glucose, HbA1C, HOMA index and higher adiponectin levels were observed in Group A compared to Group B. Conclusions. In type 2 diabetic hypertensive patients, the association of Telm 80 mg and RSG 4 mg seems to display a metabolic advantage compared to Aml 10 mg. The simultaneous beneficial effects on blood pressure and insulin sensitivity may confer make Telm particularly suitable in the treatment of the metabolic syndrome.

Point of Care Glucose Testing in Neonatal Hypoglycemia

Abstract: Neonatal hypoglycemia is a common problem in nurseries and has been associated with adverse neurodevelopmental consequences. Detection of hypoglycemia in the neonate requires accurate and reliable measurement of blood glucose concentrations. Point of care testing devices have advanced the ability of caretakers to rapidly monitor blood glucose levels at the bedside. However, care must be taken when interpreting low glucose measurements on point of care testing devices in the neonatal population. Although no device has been definitively shown to satisfy guidelines set forth by the National Committee for Clinical Laboratory Standards and the American Diabetic Association in measuring low glucose values, some do show higher sensitivities and negative predictive values. The clinical status of the patient and the inherent bias within the device can have a significant impact on the accuracy of the glucose measurements and must be kept in mind when interpreting results. In addition, adherence to quality control and attention to storage and to the expiration of reagents are crucial. It is best to involve a multidisciplinary committee involving clinical and laboratory personnel to choose the appropriate device, perform appropriate validation studies, and monitor its effectiveness.

Blood glucose on day of intensive care unit admission as a surrogate of subsequent glucose control in intensive care

Purpose The aim of the study was to test whether the mean of the highest and lowest glucose values on day 1 (Glu 1) is a useful surrogate marker of mean blood glucose during the totality of intensive care unit (ICU) stay (Glu tot). Materials and Methods Glu tot values were extracted from electronically stored biochemical databases (point-of-care laboratory) and Glu 1 values from electronically stored prospectively collected patient databases in ICUs of 4 hospitals from January 2000 to October 2004. Statistical assessment of relationship between Glu 1 and Glu tot was done. Results There were 197 227 blood glucose measurements for 8039 patients. The average of all blood glucose measurements was 8.22 ± 2.75 mmol/L. The difference between the average of all glucose values (N = 197 227) and average of Glu 1 (n = 8039) was 0.17 mmol/L. This difference in each hospital was also small (0.26, −0.13, 0.12, and 0.37 mmol/L, respectively). Conclusions Glu 1 was a good predictor of Glu tot across all study hospitals. This observation makes it possible to use Glu 1 as a surrogate of glucose control during ICU stay and opens the door to understanding ICU glucose control across the whole of Australia and New Zealand.

Syncope and falls due to timolol eye drops

The prevalence of glaucoma increases with age.1 Timolol, a non-selective β blocker, is the first line treatment. We present three cases from our falls clinic, in which we show that...

Assessment of Glycemic Control After Islet Transplantation Using the Continuous Glucose Monitor in Insulin-Independent Versus Insulin-Requiring Type 1 Diabetes Subjects

The aim of this study was to assess and compare glycemic control using the continuous glucose monitor (CGMS, Medtronic Minimed, Northridge, CA) in type 1 diabetes mellitus (T1DM) subjects who are insulin-independent versus those who require insulin after islet transplantation alone (ITA). Glycemic control was assessed using 72-h CGMS in eight T1DM subjects who were insulin-independent after ITA (ITA-II), eight T1DM subjects who were C-peptide-positive but insulin-requiring after ITA (ITA-IR), and eight non-transplanted (NT) T1DM subjects. Standard deviation of glucose values was not significantly different between ITA-II and ITA-IR subjects (ITA-II, 1.2 +/- 0.1 mM; ITA-IR, 2.0 +/- 0.3 mM; P = 0.072). Both ITA groups were more stable than NT subjects (NT, 3.3 +/- 0.3 mM; P = 0.001 vs. ITA). Mean high glucose values were significantly lower in ITA subjects compared with NT subjects (ITA-II, 10.5 +/- 0.6 mM; ITA-IR, 13.0 +/- 1.0 mM; NT, 16.1 +/- 1.1 mM; P = 0.002). Mean average glucose values were not significantly different among all groups (ITA-I, 6.7 +/- 0.2 mM; ITA-IR, 7.8 +/- 0.3 mM; NT, 7.7 +/- 0.6 mM; P = 0.198). Mean low glucose values were significantly higher in both ITA groups compared with NT subjects (ITA-II, 4.5 +/- 0.2 mM; ITA-IR, 4.3 +/- 0.3 mM; NT, 3.0 +/- 0.2 mM; P = 0.003). Duration of hypoglycemic excursions (<3.0 mM) was markedly reduced in both ITA groups (ITA-II, 0%; ITA-IR, 2.4 +/- 0.2%; NT, 11.8 +/- 4.2%). Glycated hemoglobin was not significantly different between ITA groups (ITA-II, 6.4 +/- 0.2%; ITA-IR, 6.5 +/- 0.3%) and was significantly higher in NT subjects (8.3 +/- 0.2%; P < 0.001 vs. ITA). CGMS monitoring demonstrates that glycemic lability and hypoglycemia are significantly reduced in C-peptide-positive islet transplant recipients, whether or not supplementary, exogenous insulin is used, compared with non-transplanted T1DM subjects.

Plasminogen Activator Inhibitor 1 Gene Polymorphism and Gestational Diabetes Mellitus

Plasminogen activator inhibitor 1 is thought to play a role in the pathogenesis of obesity and insulin resistance. Therefore, we examined a single nucleotide exchange in this gene in women with gestational diabetes mellitus. A total of 887 unselected women were prospectively screened for gestational diabetes mellitus by oral glucose testing between the 24th and 28th weeks of gestation. Eighty white women of this collective, 40 patients with a pathological oral glucose tolerance test and 40 normal control subjects, were randomly selected. DNA samples were isolated from the sera and analyzed for the functional -675 4G/5G promotor polymorphisms of the plasminogen activator inhibitor 1 gene. Women with gestational diabetes mellitus were significantly older and had a significantly higher body mass index (BMI) than those who did not have gestational diabetes mellitus. Women with normal glucose tolerance were significantly more often homozygous for the 5G allele (P = .01), independently of maternal age or BMI. Low fasting glucose values in the oral glucose tolerance test were significantly related to homozygosity for 5G (P = .02). Homozygosity for the 5G allele of the plasminogen activator inhibitor 1 gene is associated with normal glucose tolerance in pregnant women. These findings further support a possible role of plasminogen activator inhibitor in the development of gestational diabetes mellitus. II-2.

Model predictive glycaemic regulation in critical illness using insulin and nutrition input: A pilot study

Stress-induced hyperglycaemia is prevalent in intensive care, impairing the immune response. Nutritional support regimes with high glucose content further exacerbate the problem. Tight glucose control has been shown to reduce mortality by up to 43% if levels are kept below 6.1 mmol/L. This research develops a control algorithm with insulin and nutritional inputs for targeted glucose control in the critically ill. Ethics approval for this research was granted by the Canterbury Ethics Committee. Proof-of-concept clinical pilot trials were conducted on intubated, insulin-dependent Christchurch ICU patients ( n = 7) on constant nutritional support. A target 10–15% reduction in glucose level per hour for a desired glucose level of 4–6 mmol/L was set. 43% and 91% of glucose targets were achieved within ±5 and ±20%, respectively. The mean error was 8.9% (0.5 mmol/L), with an absolute range [0, 2.9] mmol/L. End glucose levels were 40% lower compared to initial values. All large target errors are attributable to sudden changes in patient physiology at low glucose values, rather than systemic deficiencies. Target errors are consistent with and explainable by published sensor error distributions. The results show that intensive model-based glucose management with nutrition control reduced absolute glucose levels progressively while reducing the severity of glycaemic fluctuation even with significant inter-patient variability and time-varying physiological condition. Trials spanning longer periods of time are in development to verify the short-term pilot studies performed and to test the adaptability of the controller. Clinically, these results indicate potential in clinical use to reduce ICU mortality as well as reduce risk of severe complications.

Reliability of point-of-care testing for glucose measurement in critically ill adults*

Glycemic control is increasingly being recognized as a priority in the treatment of critically ill patients. Titration and monitoring of insulin infusions involve frequent blood glucose measurement to achieve target glucose ranges and prevent adverse events related to hypoglycemia. Therefore, it is imperative that bedside glucose testing methods be safe and accurate. To determine the accuracy and clinical impact of three common methods of bedside point-of-care testing for glucose measurements in critically ill patients receiving insulin infusions. Prospective observational study. A 21-bed mixed medical/surgical intensive care unit of a tertiary care teaching hospital. Thirty consecutive critically ill patients who were vasopressor-dependent (n = 10), had significant peripheral edema (n = 10), or were admitted following major surgery (n = 10). Findings from three different methods of glucose measurement were compared with central laboratory measurements: (1) glucose meter analysis of capillary blood (fingerstick); (2) glucose meter analysis of arterial blood; and (3) blood gas/chemistry analysis of arterial blood. Patients were enrolled for a maximum of 3 days and had a maximum of nine sets of measurements determined during this time. Clinical agreement with the central laboratory was significantly better with arterial blood analysis (69.9% and 76.5% for glucose meter and blood gas/chemistry analysis, respectively) than with capillary blood analysis (56.8%; p = .039 and .001, respectively). During hypoglycemia, clinical agreement was only 26.3% with capillary blood analysis and 55.6% and 64.9% for glucose meter and blood gas/chemistry analysis of arterial blood (p = .010 and <.001, respectively). Glucose meter analysis of both arterial and capillary blood tended to provide higher glucose values, whereas blood gas/chemistry analysis of arterial blood tended to yield lower glucose values. The magnitude of the differences in the glucose values offered by the four different methods of glucose measurement led to frequent clinical disagreements regarding insulin dose titration in the context of an insulin infusion protocol for aggressive glucose control.

Relationship between smoking habits and the features of the metabolic syndrome in a non-diabetic population

Introduction Cigarette smoking is a risk factor for type 2 diabetes mellitus. The effect of smoking on the pathogenic factors for the development of diabetes is little explored. We evaluate the relation of smoking with the features of the insulin resistance syndrome, insulin resistance, and insulin secretion. Methods 2412 non-diabetic men, aged 35–65 years, were studied. Smoking habit was investigated by questionnaire. Anthropometry, blood pressure, forced expiratory volume (FEV1), fasting glucose, triglycerides, total and HDL cholesterol, plasma free fatty acids (FFA), insulin and fibrinogen were measured. HOMA-IR and HOMA β cell were calculated. The metabolic syndrome was defined according to ATP III criteria. Results The metabolic syndrome was more prevalent in smokers than non-smokers (OR: 1.34; 95% CI 1.01–1.77). This was mainly due to a higher prevalence of dyslipidemia – high triglycerides (46.1% vs 29.9%, p < 0.001), or low HDL cholesterol (42.2% vs 30.4%, p < 0.001), in smokers. In smokers, other features of insulin resistance – i.e. obesity, hypertension, and hyperglycemia were significantly less frequent and FFA were lower ( p < 0.001). Plasma insulin and HOMA β cell were similar in the two groups (8.3 vs 8.0 μU/ml and 80.7% vs 82.9%, respectively), but HOMA-IR was significantly lower in smokers ( p < 0.001) due to the lower glucose values observed in these people. Conclusions Among the features of the metabolic syndrome, only dyslipidemia is associated with chronic smoking. Smoking in not associated with enhanced insulin resistance, or with impaired insulin secretion. Alternative hypotheses should be explored for the increased risk of diabetes in smokers.

Diagnostic values of combined glucose and lactate values in cerebrospinal fluid and vitreous humour—our experiences

The final diagnosis of death in hypoglycaemic or diabetic coma should always be done as a synopsis of anamnestic response, morphology, biochemical (glucose, lactate, HBA1c, ketonic bodies, insulin, and C-peptide) and toxicological findings. High glucose levels in vitreous humour (more than 13 mmol/L, 234 mg/dL) or combined values of glucose and lactate in vitreous humour or in cerebrospinal fluid over threshold values of 23.7 mmol/L (427 mg/dL) and 23.4 mmol/L (422 mg/dL) respectively, can be an indicator of the pre-mortem hyperglycaemic state with fatal outcome. The determination of glycated haemoglobin, acetone and other ketone bodies improve the diagnostic values of the whole procedure. Diabetic ketoacidosis (blood aceton >0.3 g/L) is more often the cause of death of diabetic patients than the non-ketotic hyperosmolal state. Hypoglycaemia is deemed fatal if the combined values are lower than 5.5 mmol/L (100 mg/dL) and can not be excluded if they are lower than 8.9 mmol/L (160 mg/dL). Two cases of detected hypoglycaemia are described further. A psychiatric patient with diabetes (Hba1c 8.4%) committed suicide with an insulin overdose. The combined values of glucose and lactate in vitreous humour and in cerebrospinal fluid were 3.3 and 4.1 mmol/l, respectively. In another case a low combined glucose and lactate value (8.7 mmol/L) in vitreous humour indicated, besides the high concentration of glibenclamide (0.9 mg/L) in the blood of a driver with a poorly controlled diabetic condition (Hba1c = 10.6%), a state of decreasing blood glucose in the time before the accident causing the driver to feel unwell and behave inappropriately.

Nonlinear model predictive control of glucose concentration in subjects with type 1 diabetes

A nonlinear model predictive controller has been developed to maintain normoglycemia in subjects with type 1 diabetes during fasting conditions such as during overnight fast. The controller employs a compartment model, which represents the glucoregulatory system and includes submodels representing absorption of subcutaneously administered short-acting insulin Lispro and gut absorption. The controller uses Bayesian parameter estimation to determine time-varying model parameters. Moving target trajectory facilitates slow, controlled normalization of elevated glucose levels and faster normalization of low glucose values. The predictive capabilities of the model have been evaluated using data from 15 clinical experiments in subjects with type 1 diabetes. The experiments employed intravenous glucose sampling (every 15 min) and subcutaneous infusion of insulin Lispro by insulin pump (modified also every 15 min). The model gave glucose predictions with a mean square error proportionally related to the prediction horizon with the value of 0.2 mmol L−1 per 15 min. The assessment of clinical utility of model-based glucose predictions using Clarke error grid analysis gave 95% of values in zone A and the remaining 5% of values in zone B for glucose predictions up to 60 min (n = 1674). In conclusion, adaptive nonlinear model predictive control is promising for the control of glucose concentration during fasting conditions in subjects with type 1 diabetes.

The melanocortin agonist melanotan II increases insulin sensitivity in OLETF rats

Effects of peripheral administration of melanotan II (MTII), a melanocortin agonist, on insulin sensitivity and glucose tolerance were examined in Otsuka Long-Evans Tokushima Fatty (OLETF) rats. Subcutaneous administration of MTII with osmotic mini-pumps decreased food intake and body weight in OLETF rats. MTII group showed more sensitivity to insulin compared with that allowed to eat ad libitum or pair-fed group in insulin tolerance tests on day 9. MTII group also showed significantly lower glucose values than ad libitum group in glucose tolerance tests on days 11 and 23. Thus, MTII increased insulin sensitivity and improved glucose tolerance in OLETF rats.

Insulinoma Maligno Produzindo Hipoglicemia

Relatamos o caso de uma mulher de 53 anos com episódios de hipoglicemia espontânea com um ano de evolução. A paciente referia fraqueza, sudorese e tremores, especialmente após as refeições. A avaliação laboratorial confirmou hipoglicemia com altos níveis de insulina e peptídeo C. A tomografia axial computadorizada (TAC) de abdome evidenciou uma grande massa com calcificações na cauda do pâncreas. Após ressecção cirúrgica o exame histológico revelou insulinoma maligno. Após 12 meses de acompanhamento a paciente permanecia assintomática e normoglicêmica.

Assessment and modeling of poly(vinyl alcohol) bioartificial pancreas in vivo

Pancreatic islets surrounded by a semipermeable membrane to prevent an immune response by the host immunosystem is a potential way of treating type I diabetes mellitus. Our previous in vitro studies have demonstrated that poly(vinyl alcohol) (PVA) membranes satisfy the basic requirements for a bioartificial pancreas. This study was designed to evaluate the performance of PVA tubular membrane chambers containing islets in vivo. When the m-2 type of PVA chamber was implanted into streptozotocin-induced diabetic rats, nonfasting blood glucose levels dropped from 500±35mg/dl to the lowest value 210±22mg/dl. Furthermore, the performance of the bioartificial pancreas can be enhanced by the increased numbers of implanted chambers. If three m-2 chambers were implanted, nonfasting blood glucose levels in the diabetic rats decreased to 130–160mg/dl and such a low blood glucose value was maintained for 1 month. This indicates that implanting three m-2 chambers in the diabetic rats could provide improved permeability of insulin to normalize blood glucose levels and improved survival of islets from the immune system of the recipient. For improving the design of the bioartificial pancreas, a mathematical model was developed to account for the changes in blood glucose levels of the diabetic rats. We demonstrated such a mathematical analysis was helpful to understand the characteristics of islet inside an artificial environment.

Hypoglycaemic neuropathy in diabetic BB/Wor rats treated with insulin implants affects ventral root axons but not dorsal root axons.

It is believed that hyperglycaemia underlies diabetic neuropathy. However, low blood glucose values may also cause pathological changes in peripheral nerves and in neuronal perikarya. This study examined spinal roots, dorsal root ganglia and the ventral horn at the segmental level L5 in long-term insulin-treated eu-/hypoglycaemic diabetic rats with an obvious plantar nerve pathology. The purpose was to determine whether hypoglycaemic neuropathy affects sensory and/or motor neurons at root and/or perikaryal levels. Electron microscopic examination of dorsal roots from eu-/hypoglycaemic rats showed a normal qualitative morphology and normal numbers of unmyelinated and myelinated axons. In ventral roots the picture varied. Whereas two rats exhibited an essentially normal morphology, three rats presented moderate or marked signs of pathology such as clusters of small and medium-sized myelinated axons, medium-sized myelinated axons with abnormally thin sheaths, large unmyelinated axons and signs of past or ongoing axonal degeneration. Light microscopic examination of the L5 dorsal root ganglion and ventral horn showed a qualitatively normal picture in eu-/hypoglycaemic rats and the mean number of large ventral horn neurons per section was normal. These results suggest that the type of eu-/hypoglycaemia examined here affects ventral root axons but not dorsal root axons, that the degree of ventral root pathology is variable and that sensory and motor neuron perikarya do not appear to be affected.

Hypoglycemia in the neonate

After a brief history of the development of neonatal hypoglycemia, this review emphasizes the current approach to the anticipation, diagnosis, and management of the neonate with a low plasma glucose concentration. Current techniques for studying the neurophysiological and endocrine-metabolic effects of significant hypoglycemia provide new approaches for establishing relevant definitions of significant hypoglycemia, its prognosis, and pathogenesis. The inadequacy of glucose oxidase strips for screening, the definition of high-risk infants, new definitions for low plasma glucose concentrations, and their treatment are presented as well as the ability of the neonate to respond to significantly low glucose values. New data concerning the hereditary aspects of hyperinsulinemia (Glaser, this issue), hereditary defects in branched-chain amino acid, 3-methylglutaconic aciduria and mitochondrial betaoxidation, and degradation of fatty acids (Ozand, this issue), the role of glucose transporters (Vannucci and Vannucci, this issue), and the newer computed tomography and magnetic resonance imaging techniques (Kinnala, this issue) to study neonatal hypoglycemia are reviewed elsewhere in this issue.

Association of apolipoprotein (Apo)E genotype with plasma apo E levels

The purpose of this study was to investigate the effects of apolipoprotein (apo) E genotype on plasma apo E levels as well as serum total, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, and glucose values in 734 middle-aged and elderly, female and male subjects. Apo E allele frequencies were similar to those reported in other Caucasian populations. After adjustment for medications, alcohol use, smoking, age, and body mass index, apo E genotype was noted to have significant effects on apo E, total cholesterol, LDL cholesterol, and glucose levels in females, and on apo E, LDL cholesterol, and HDL cholesterol levels, as well as the total cholesterol (TC)/HDL cholesterol ratio in males. Female and male subjects with the apo E4 allele had significantly ( P<0.05) lower plasma apo E (25 and 15%) and higher LDL cholesterol levels (5 and 2%), while those with the apo E2 allele had significantly ( P<0.05) higher apo E (32 and 27%) and lower LDL cholesterol levels (10 and 10%) than the apo E3/3 group. Moreover, female apo E4 carriers had significantly ( P<0.05) lower glucose values (11%) than the apo E3/3 group. These data are consistent with the concept that, in addition to the well known effects of apo E genotype on LDL-C values, this locus plays a very significant role in modulating plasma apo E levels.

Effects of Age and Captivity on Plasma Chemistry Values of the Egyptian Vulture

Despite the interest in blood chemistry for studying ecological and pathological characteristics of birds, sources of variability such as age and captivity are poorly understood, and reference values usually are obtained from adult captive birds. We determined 15 plasma chemical variables for 164 free-living Egyptian Vultures (Neophron percnopterus) of three age groups (nestlings, subadults, and adults), and for 9 captive adults. Free-living subadults and adults exhibited identical plasma chemistry values. Nestlings had significantly higher levels of creatinine, urate, urea, triglycerides, calcium, phosphorus, and alkaline phosphatase (AP) than both free-living subadults and adults, but lower values of glucose and aspartate aminotransferase (AST). Captive adults had significantly higher levels of total protein, albumin, creatinine, urate, cholesterol, calcium, phosphorus, and AST than free-living adults, which we attribute to differences in diet quality and physical activity. We conclude that future studies should consider age as a major source of variability in avian plasma chemistry, and that results obtained from captivity should be used cautiously to interpret plasma chemistry in the study and rehabilitation of wild birds.

Utility of Serum Electrolytes in the Management of Dehydration 391

Background: The serum electrolyte panel (SEP) is a frequently ordered laboratory test and of unproved utility in the management of dehydrated pediatric patients. Many clinicians believe that the bicarbonate level may be predictive of patient outcome. Our purpose is to study the incidence of SEP abnormalities and assess their role in management.Methods: Children between the ages of 2 months and 18.8 years receiving intravenous fluids for dehydration were prospectively studied. Historical data, physical examination findings, degree of dehydration and SEP were obtained. Attending physicians documented prior to knowing laboratory results whether they would have ordered a SEP. Outcome measures included changes of management based on SEP, disposition, and return visits within 48 hours. Results: 206 patients were entered with a median age of 19.2 months. 123 patients presented with mild (≤5%), 81 with moderate (6-10%) and 2 with severe dehydration (>10%). The incidence of SEP abnormalities was 46% for one or more abnormal values. 29% had BUN levels > 17mg/dl, 26% had bicarbonate levels 150mmol/L. Considering the 54 patients with bicarbonates <16mmol/L; 27 were discharged home, 22 were placed into observation and 5 were admitted. At 95% significance, bicarbonate was lower in those placed into the observation unit versus those discharged home. There was no correlation between low bicarbonate and admission rates or return visits. The attending thought a SEP was needed in 33% of the cases. Knowing the SEP did not change management in 91%. In 17 patients the SEP changed management; 5 with low glucose values received glucose sooner, 5 with low bicarbonate levels were observed longer, 3 with reassuring values were sent home sooner, and 2 with low potassium levels received potassium. There were 10 return visits requiring IV fluids within 48 hours, 8 (2 with bicarbonates <16) were admitted. Conclusion: Although there were a large number of SEP abnormalities, there was minimal effect on clinical management or patient outcome. Low bicarbonate levels were predictive of observation unit placement but not for need of hospitalization or patient return visits.