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Hyeprglycemia
Hyperglycemia
| Question | Answer |
|---|---|
| What happens in hyperglycemic ICU patients? | They exhibit increased euronal damage, increased platelet aggregation and decreased artlerial levels of FFAs due to insulin |
| What does cytokine levels cause in patients with hyperglycemia? | increased cytokines from hyperG lead to inflammation |
| neutrophil dysfunction can lead to: | adherence, chemotaxis, phagocytosis, extravasation, and complement activity that are all inhibited by increased glucose concentrations |
| Dehydration and glucosuria affected: | intrvascular fluid balance |
| Whare the consequences of hypergylcemia in ICU patients? | increased mortality (from both cardiac and non cardiac reasons), increased sternal wound infections, and stroke |
| Intensive insulin therapy dose two important things: | 1. It decreases glucose levels (duh) 2. it has an anabolic effect and promotes protein and glycogen synthesis and inhibits lipolysis |
| What did the LEUVIN I study show? | that intensive glycemic control = 80 to 110 vs. conventional treatment of 180 to 200 does benefit a patient it seems |
| The Stamford project targeted: | less than 140mg/dL |
| The NICE-SUGAR trial: | intensive tx lead to 81 to 108 mg/dL while conventional treatment kept it always below 180. The mean of intensive was 115 vs. 144 for conventional |
| Question is what is the benefit? | The risk of a hypoglycemic incien |
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