Hypoglycemia risk factors in ICU
We hear a lot about effects of hyperglycemia in ICU but on the other end of spectrum, hypoglycemia could be actually more or atleast equally disastrous. Dr. Vriesendorp and coll. from Amsterdam, The Netherlands looked into record of 2,272 patients and found that 156 patients (6.9%) experienced at least one episode of hypoglycemia (glucose value less than 45 mg/dL). They found following risk factors for hypoglycemia in ICU.
- CVVHD with bicarbonate-based substitution fluid,
- Decrease of nutrition without adjustment for insulin infusion,
- History of diabetes mellitus,
- Insulin use,
- Inotropic support and
- Simultaneous octreotide and insulin use.
Interestingly, Gastric residual during enteral nutrition without adjusting insulin infusion, liver failure, continuous venovenous hemofiltration with lactate-based substitution fluid, diminished glomerular filtration rate, dose diminishment of glucocorticoids or catecholamines, and use of β-blocking agents were not associated with hypoglycemia.
Related Previous Pearl:
Reference: (click to get abstract)
Predisposing factors for hypoglycemia in the intensive care unit - Critical Care Medicine. 34(1):96-101, January 2006.