Management of parenteral nutrition in acutely ill patients with hyperglycemia.

Many hospital clinicians manage patients with hyperglycemia receiving nutrition support. Recent studies underscore the importance of tight glucose control in hospitalized patients. Over the short term, hyperglycemia can adversely affect fluid balance, immune function, inflammation, and outcome; glucose control can improve these effects. Because this appears to be true for patients with and without a known diagnosis of diabetes, hyperglycemia should be aggressively treated in all patients. Avoidance or minimization of hypoglycemia also is important. In general, the nutrition assessment, indications for nutrition support, and estimate of nutrition requirements for critically ill patients with hyperglycemia are similar to those of nondiabetic patients. Because overfeeding may cause hyperglycemia, appropriate provision of calories is essential. Although the technology to deliver tight glycemic control in intensive care unit settings is widely available, implementing a safe and effective program requires standardized approaches. Studies testing which insulin infusion safely achieves tight glucose control are limited. Further research should focus on the risks and benefits of parenteral nutrition use in this group of patients, as well as on optimal methods of achieving glucose control.