Low Blood Sugar in ICU Patents Increases Death Risk

While most people are in the intensive care unit because of either an intense health crisis or a life-threatening situation, researchers have found another reason to be extra cautious while in the ICU. A recent study found that those with moderate to severe hypoglycemia while in intensive care had a significantly higher risk of death.

Simon Finfer, MD, of the George Institute for international Health in Sydney, and his colleagues analyzed data from over 6,000 patients. The groups were divided among those with conventional blood sugar control and intensive blood sugar control. Nearly half of the group had moderate to severe hypoglycemia, and just under 4 percent had severe hypoglycemia. Most of these patents, 82 to 93 percent, were under intensive blood sugar control.

While 23.5 percent of those who did not have hypoglycemia died during their treatment in the ICU, 28.5 percent of those with moderate hypoglycemia, and 35.4 percent of those with severe hypoglycemia died during the course of treatment. Hypoglycemic patients also had a higher incidence of death from shock, neurological, cardiovascular, and respiratory issues.

The study authors note that hypoglycemia "may be a marker of impending death rather than a cause of subsequent death. (A) causal relationship is plausible because hypoglycemia may increase mortality by means of impairment of autonomic function, alteration of blood flow and composition, white-cell activation, vasoconstriction, and the release of inflammatory mediators and cytokines."

Call for Better Blood Sugar Control

While the cause and effect relationship could not be established within the confines of the study, the authors concur:

"(It seems) prudent to ensure that strategies for managing the blood glucose concentration focus not only on the control of hyperglycemia but also on avoidance of both moderate and severe hypoglycemia, The use of more conservative glucose targets is unacceptable, and older, nonchalant attitudes need to be abandoned."


Sources:
http://www.medpagetoday.com/CriticalCare/GeneralCriticalCare/34863
http://www.nejm.org/doi/full/10.1056/NEJMoa0810625

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