RT Book, Section
A1 Ciment, Ari
A1 Romero, Joseph
A1 Saha, Debjit
A2 Farcy, David A.
A2 Chiu, William C.
A2 Marshall, John P.
A2 Osborn, Tiffany M.
SR Print(0)
ID 1135702688
T1 Glucose Management in Critical Care
T2 Critical Care Emergency Medicine, 2e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071838764
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1135702688
RD 2024/04/24
AB The  American  Diabetes  Association  (ADA)  defines  inpatient  hyperglycemia  as  a  fasting  blood  glucose  (BG)  >126  mg/dL  or  a  random  BG  >200  mg/dL  that  reverts  to  normal  after  discharge.1  The  prevalence  of  hyperglycemia  in  the  acutely  ill  patient  in  the  intensive  care  unit  (ICU)  has  been  shown  to  be  as  high  as  83%.2  Hyperglycemia  in  critical  illness  may  occur  due  to  stress-related  surges  in  counterregulatory  hormones,  preexisting  diabetes,  impaired  glucose  tolerance,  and  insulin  resistance.  Whether  it  is  a  condition  necessitating  intervention  or  a  marker  of  disease  severity,  hyperglycemia  has  been  shown  to  be  an  independent  risk  factor  for  increased  mortality  in  the  ICU.3  Despite  this  association,  tight  glycemic  control  (TGC)  has  not  been  shown  to  consistently  improve  patient  outcomes  and,  surprisingly,  may  cause  more  harm  than  good  in  some  subgroups.  This  chapter  examines  the  historical  background,  essential  pathogenesis,  associations,  key  clinical  studies,  current  protocols,  and  recommendations  regarding  hyperglycemia  in  the  critically  ill.