title: Acute cellular insulin resistance and hyperglycemia associated with hypophosphatemia after cardiac surgery.
abstract: Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. Insulin resistance has been reported and linked to low serum phosphate levels in animal models and studies in diabetic outpatients, but not in postoperative patients. The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing hypophosphatemia.
authors.affiliation: From the Departments of *Anesthesiology, Perioperative and Pain Medicine, and ‖Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California; †Department of Critical Care, Lakeridge Health, Oshawa, Ontario, Canada; ‡Department of Medicine, Queen's University, Ontario, Canada; and §Department of Cardiovascular Surgery, Hoag Memorial Hospital, Newport Beach, California.
authors.forename: Esther
authors.initials: E
authors.lastname: Garazi
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bridge
authors.forename: Anthony
authors.initials: A
authors.lastname: Caffarelli
authors.forename: Stephen
authors.initials: S
authors.lastname: Ruoss
authors.forename: Pieter
authors.initials: P
authors.lastname: Van der Starre
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D006348:Cardiac Surgical Procedures; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D017674:Hypophosphatemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D007333:Insulin Resistance; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin