Critical Care Medicine
1. Description of the problem
What every clinician needs to know
Hypoglycemia may be associated with mortality and neurologic complications such as seizures and coma.
It is uncertain what the clinical consequences from hypoglycemia are in ICU patients.
In diabetes patients, hypoglycemia is associated with:
Diverse symptoms such as anxiety, palpitations, tremor, sweating, hunger and paresthesias.
Neurologic symptoms such as behavioral changes, cognitive dysfunction, seizures and coma.
Key management points
Stop insulin infusion.
Check blood glucose within 30-60 minutes.
2. Emergency Management
Emergency management steps
Stop insulin infusion (and oral antidiabetic agents).
Administer 10 to 20 mL Glucose 50% intravenously.
Check blood glucose concentration within 30 to 60 minutes.
Drugs and dosages
Establishing a specific diagnosis
Different cutoffs have been used in literature to define hypoglycemia in ICU patients. These range from lower than 81 mg/dL to lower than 40 mg/dL. Generally, blood glucose concentration below 60 mg/dL is considered to be hypoglycemia.
Normal lab values
Normal blood glucose: 80-110 mg/dL
Glucose is the obligate fuel for the brain. Glucose cannot be synthesized by the brain, and glycogen storage supplies last for only minutes. Low blood glucose will therefore result in brain damage.
Tight blood glucose control in ICU patients is associated with an increased incidence of hypoglycemia and also with increased mortality, and may occur in up to 28% of patients.
What's the evidence?
Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.
No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.
Clinical Pain Advisor Articles
- Non-Opioid Therapies for Pain Management in the ED
- CBT vs Pain Education for Chronic Pain in Low-Income Clinics
- Factors Predicting Pain Outcomes After TKR for Knee Osteoarthritis
- Betel Quid Addiction and Implications for Substance Use Disorder
- Peripherally Acting Opioid and Cannabinoid May Be Effective for Neuropathic Pain
- Exploring the Connections Between Neuropathic Pain and Comorbid Mood Disorders
- Medical Marijuana Laws, Dispensaries May Reduce Deaths From Opioid Overdose
- Ketamine Infusion May Be Effective for the Short-Term Relief of CRPS-Associated Pain
- An Avenue for the Development of Opioid Adjuncts for Enhanced Analgesia, Reduced Abuse Potential
- Peripheral Neuropathy Management in the Primary Care Setting: A Guide
- Once-Monthly Erenumab Injections May Be Effective for Episodic Migraine Prophylaxis
- The Pros and Cons of Direct-to-Consumer Genetic Testing
- Predicting Best Outcomes of Intra-Articular Hyaluronic Acid Treatment in Knee OA
- Virtual Reality as a Distraction From Pain During Medical Procedures
- Low Back Pain: Contributing Factors, Prophylactic Strategies, and Effective Treatments