Hyperglycemia was noted in the laboratory results. Why is hyperglycemia of concern in the critically ill patient? How was this handled for this patient? What are the current recommendations for glycemic control in critically ill paitents?
What will be an ideal response?
Hyperglycemia has been shown to correlate with poor outcomes in the ICU patient. It has been shown to lead to increased length of stay and higher risk of in-hospital mortality. Also, in patients with known DM before admission, it has been shown to increase the risk for infection and shock. For our patient, the hyperglycemia was treated using an insulin drip protocol, which is a commonly used therapy in critically ill patients. Tight blood glucose control (80-110 mg/dL) does not confer advantages in these patients. Both Society of Critical Care Medicine (SCCM) and ASPEN recommends a goal of 110 to 150 mg/dL while the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists recommends a goal of 140-180 mg/dL as a reasonable goal for these patients.
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