Susan Shapiro Braithwaite1,2, Dharmesh B Bavda3, Thaer Idrees3, Faisal Qureshi4, Oluwakemi T Soetan3. 1. , 1135 Ridge Road, Wilmette, IL, 60091, USA. susan.s.braithwaite@gmail.com. 2. Endocrinology Consults and Care, S.C, 3048 West Peterson Ave, Chicago, IL, 60659, USA. susan.s.braithwaite@gmail.com. 3. Presence Saint Joseph Hospital-Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA. 4. , 2800 N Sheridan Road Suite 309, Chicago, IL, 60657, USA.
Abstract
PURPOSE OF REVIEW: We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients. RECENT FINDINGS: Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates. In order to reduce the risk for hypoglycemia in the ICU, caregivers should define responses to interruption of continuous carbohydrate exposure, incorporate transitioning strategies upon initiation and interruption of IV insulin, define modifications of antihyperglycemic therapy in the presence of worsening renal function or chronic kidney disease, and anticipate the effects traceable to other medications and substances. Institutional and system-wide quality improvement efforts should assign priority to hypoglycemia prevention.
PURPOSE OF REVIEW: We reviewed the strategies associated with hypoglycemia risk reduction among critically ill non-pregnant adult patients. RECENT FINDINGS:Hypoglycemia in the ICU has been associated with increased mortality in a number of studies. Insulin dosing and glucose monitoring rules, response to impending hypoglycemia, use of computerization, and attention to modifiable factors extrinsic to insulin algorithms may affect the risk for hypoglycemia. Recurring use of intravenous (IV) bolus doses of insulin in insulin-resistant cases may reduce reliance upon higher IV infusion rates. In order to reduce the risk for hypoglycemia in the ICU, caregivers should define responses to interruption of continuous carbohydrate exposure, incorporate transitioning strategies upon initiation and interruption of IV insulin, define modifications of antihyperglycemic therapy in the presence of worsening renal function or chronic kidney disease, and anticipate the effects traceable to other medications and substances. Institutional and system-wide quality improvement efforts should assign priority to hypoglycemia prevention.
Entities:
Keywords:
Best practices; Critical care; Critical care protocols; Hypoglycemia; Insulin infusion; Insulin protocol
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