Sir.—The article entitled "Recurrent Hyperglycemia Associated With Sepsis in a Newborn" (Journal 133:645-646, 1979) was of interest to me. We have also seen several cases of hyperglycemia associated with sepsis over the past several years. Most of these infants were receiving partial or total intravenous alimentation at the time of the sepsis. Our conclusion was that any infant who did not tolerate a previously tolerated glucose infusion was considered as having sepsis until proven otherwise.
I cannot accept the explanation offered by the authors for the hyperglycemia seen in sepsis: namely, an inadequate insulin response. I would suggest that sepsis, especially that caused by Gram-negative organisms, is associated with endotoxin release. General cellular metabolism is decreased at this time, as is glucose utilization; thus, hyperglycemia would result.