Abstract The purpose of this report is to describe 4 cases of varicella in infancy associated with fatal hypoglycemia. A hypothesis has been developed which relates the observed hypoglycemia to the effects of salicylates, and an attempt has been made to substantiate this hypothesis experimentally. Report of Cases Case 1.—This 4-month-old white female was considered entirely well until she developed chickenpox after exposure to an older sibling. The pregnancy, delivery, and her growth and development were entirely normal. She received her second dose of diphtheria and tetanus toxoids and pertussis vaccine 3 days before the onset of varicella. On the third day of the illness she vomited all feedings, and on the fourth day she was admitted because of unresponsiveness and emesis of coffee-ground material.On physical examination she was a well-developed and nourished, comatose and flaccid infant who weighed 8.1 kg.; her temperature was 36.5 C (97.7 F), pulse References 1. Karsner, H. T.: Human Pathology , Ed. 8, Philadelphia, J. B. Lippincott Company, 1955, p. 607. 2. Applebaum, E.; Rachelson, M. H., and Dolgopol, V. B.: Varicella Encephalitis , Amer. J. Med. 15:223-230, 1953.Crossref 3. Nelson, N.: Photometric Adaptation of Somogyi Method for Determination of Glucose , J. Biol. Chem. 153:375-380, 1944. 4. Somogyi, M.: Determination of Blood Sugar , J. Biol. Chem. 160:69-73, 1945. 5. Schmidt, E. G., and Carey, T. N.: Terminal Hypoglycemia , Arch. Intern. Med. 47:128-134, 1931.Crossref 6. Hill, E. V.: Significance of Dextrose and Nondextrose Reducing Substances in Postmortem Blood , Arch. Path. 32:452-473, 1941. 7. Naumann, H. N.: Diabetes and Uremia Diagnosed at Autopsy by Testing Cerebrospinal Fluid and Urine , Arch. Path. 47:70-77, 1949. 8. Review: Effect of Salicylates on Carbohydrate Metabolism , Nutr. Rev. 13:46-48, 1955. 9. Winters, R. W.; White, J. S.; Hughes, M. C., and Ordway, N. K.: Disturbances of Acid-Base Equilibrium in Salicylate Intoxication , Pediatrics 23:260-285, 1959. 10. Reid, J.; MacDougall, A. I., and Andrews, M. M.: Aspirin and Diabetes Mellitus , Brit. Med. J. 2:1071-1074, 1957.Crossref 11. Lutwak-Mann, C.: Effect of Salicylate and Cinchophen on Enzymes and Metabolic Processes , Biochem. J. 36:706-728, 1942. 12. Winters, R. W., and Morrill, M. F.: Carbohydrate Metabolism in Experimental Salicylism , Proc. Soc. Exp. Biol. Med. 88:409-411, 1955.Crossref 13. Sproull, D. H.: A Peripheral Action of Sodium Salicylate , Brit. J. Pharmacol. 9:262-264, 1954. 14. Smith, M. J. H.: Action of Salicylate on Metabolism of Acetate-2-C14 in the Rat , Science 128:423, 1958.Crossref 15. Barnett, H. L.; Powers, J. R.; Benward, J. H., and Hartmann, A. F.: Salicylate Intoxication in Infants and Children , J. Pediat. 21:214-223, 1942.Crossref 16. Smith, M. J. H., and Jeffrey, S. W.: Effects of Salicylate on Creatine Phosphate and Adenosine Triphosphate in Isolated Rat Diaphragm , Biochem. J. 64:589-592, 1956. 17. Brody, T. M.: Action of Sodium Salicylate and Related Compounds on Tissue Metabolism in Vitro , J. Pharmacol. Exp. Ther. 117:39-51, 1956.
American Journal of Diseases of Children – American Medical Association
Published: Apr 1, 1962