The Internet Book of Critical Care Podcast
IBCC Episode 101 - Stress Hyperglycemia in the ICU
Podcast summary created with Snipd AI
Quick takeaways
- Stress hyperglycemia in the ICU can have potential benefits like providing glucose to poorly perfused tissues, but also potential harms such as impaired urine output and capillary leak.
- Insulin therapy for stress hyperglycemia in the ICU should be approached cautiously due to potential risks and lack of high-quality evidence supporting tight glucose control.
Deep dives
Stress Hyperglycemia in the ICU: Potential Benefits and Harms
Stress hyperglycemia in the ICU occurs when glucose levels increase due to hormones such as cortisol and glucagon. This can have potential benefits, including providing glucose to poorly perfused tissues and reducing inflammation. However, there are also potential harms, such as impaired urine output as a marker for tissue perfusion, impaired function of the endothelial glycocalyx leading to capillary leak, and potential hypernatremia due to diuresis. Additionally, insulin therapy for stress hyperglycemia can have iatrogenic effects, including severe hypoglycemia and adverse drug reactions. Overall, there is no high-quality evidence to support the tight control of glucose levels in the ICU, and insulin therapy should be approached with caution due to its potential risks.
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