RT Book, Section A1 Ciment, Ari J. A1 Romero, Joseph A2 Farcy, David A. A2 Chiu, William C. A2 Flaxman, Alex A2 Marshall, John P. SR Print(0) ID 55813893 T1 Chapter 32. Glucose Management in Critical Care T2 Critical Care Emergency Medicine YR 2012 FD 2012 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-162824-2 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=55813893 RD 2024/03/28 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, in some subgroups, cause more harm than good. This chapter examines the historical background, essential pathophysiology, associations, key clinical studies, current protocols, and recommendations regarding hyperglycemia in the critically ill.