Hyperglycemia in the critically ill patient.
Hyperglycemia and insulin resistance are common among critically ill patients and occur in patients with or without a history of diabetes mellitus. All patients undergoing critical illness are at risk for stress-induced hyperglycemia. Some patients may be at greater risk for hyperglycemia than others when considering underlying disease states and iatrogenic factors. Many recent studies demonstrate that tight glucose control can decrease morbidity and mortality associated with critical illness. This article reviews the pathophysiology behind stress-induced hyperglycemia, the evidence to support tight glycemic control, and the importance of an intensive insulin therapy protocol to standardize treatment among critical care patients.
Gearhart
Michelle M
MM
Department of Pharmacy Services, University Hospital, Cincinnati, OH 45219, USA. powermm@healthall.com
Parbhoo
Shilpa K
SK
D001786:Blood Glucose / Q000378:metabolism; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000453:epidemiology; D004837:Epinephrine / Q000502:physiology; D019317:Evidence-Based Medicine; D005934:Glucagon / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000502:physiology; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance / Q000502:physiology; D009017:Morbidity; D009638:Norepinephrine / Q000502:physiology; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control; D013312:Stress, Physiological / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D014409:Tumor Necrosis Factor-alpha; D005934:Glucagon; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine