title: Glucose Disturbances and Atypical Antipsychotic Use in the Intensive Care Unit.
abstract: OBJECTIVE
  Chronic use of atypical antipsychotics may lead to metabolic abnormalities including hyperglycemia. Although evidence supports acute hyperglycemic episodes associated with atypical antipsychotic use, the acute use of atypical antipsychotics in the intensive care unit (ICU) setting has not been studied. The purpose of this study is to evaluate the occurrence of hyperglycemia in ICU patients receiving newly prescribed atypical antipsychotic.
  
  
  CONCLUSIONS
  Of the 273 patient charts reviewed, 50 patients were included in this study. Approximately 45% of patients experienced at least 1 hyperglycemic episode (blood glucose >180 mg/dL) after the initiation of an atypical antipsychotic in the ICU. Of the patients experiencing at least 1 hyperglycemic episode, 60% experienced multiple distinct hyperglycemic episodes. In this study, quetiapine was the most commonly used atypical antipsychotic, 19 (38%) patients were discharged from the ICU on the atypical antipsychotic, 6 (12%) patients died in the ICU, and 31 (62%) patients were treated with an antihyperglycemic agent. Logistic regression analysis showed that women and ICU patients with a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score were significantly more likely to have multiple hyperglycemic episodes.
  
  
  CONCLUSIONS
  Patients admitted to the ICU and initiated on an atypical antipsychotic may develop hyperglycemia independent of other glucose-elevating factors. The direct correlation of these agents to resulting acute hyperglycemia is unknown. Further studies are needed to investigate the link between atypical antipsychotics and acute hyperglycemia and the clinical significance of the impact on patient outcomes.
authors.affiliation: Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, GA, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Bishara
authors.affiliation: Department of Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA.
authors.forename: Stephanie V
authors.initials: SV
authors.lastname: Phan
authors.affiliation: Department of Clinical and Administrative Pharmacy, University of Georgia, Albany, GA, USA.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Young
authors.affiliation: Department of Pharmacy Practice, Mercer University, Mercer University Drive, Atlanta, GA, USA liao_tv@mercer.edu.
authors.forename: T Vivian
authors.initials: TV
authors.lastname: Liao
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000453:epidemiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D014150:Antipsychotic Agents
keywords: critical care; endocrinology; medication safety; transitions of care