title: Chromium infusion reverses extreme insulin resistance in a cardiothoracic ICU patient.
abstract: Insulin resistance is common and often multifactorial in acutely critically ill patients. At our institution, glycemic control is achieved in these patients using an intravenous insulin protocol. The authors present a case in which a patient developed severe insulin resistance following surgical repair of a thoracic aorta aneurysm. Postoperatively, the patient required 2110 units of insulin over 40 hours while receiving pressors and glucocorticoids. After the administration of intravenous chromium at 3 microg/h, the blood sugar normalized and insulin therapy was discontinued. This case represents a unique approach using intravenous chromium to achieve glycemic control in a patient with extreme insulin resistance and acute critical illness. Prospective clinical trials using intravenous chromium may provide the means to optimize intensive insulin therapy for critically ill patients.
authors.affiliation: Mount Sinai School of Medicine, Endocrinology, New York, NY 10128, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Via
authors.forename: Corey
authors.initials: C
authors.lastname: Scurlock
authors.forename: Jayashree
authors.initials: J
authors.lastname: Raikhelkar
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Luozzo
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mechanick
mesh_terms: D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D002857:Chromium / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D007333:Insulin Resistance; D011182:Postoperative Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D002857:Chromium