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Hyperglycemia and the Critically Ill Patient Tony Gerlach, PharmD, BCPS The Ohio State University Medical Center
Objectives ,[object Object],[object Object],[object Object]
Effects of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]
Glucose control in Healthy People with out Diabetes Insulin Release Glucagon Decrease Glucose Intake
Causes of Hyperglycemia:  Glucose Intake ,[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Hyperglycemia: Stress Response ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Hyperglycemia: Medications And Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology of Hypoglycemia in the ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term Glycemic Control and Postoperative Infection Complications %  Arch Surg 2006;141:375-80. ** Statistically Significant
Hyperglycemia and Mortality Mayo Clin Proc. 2003;78:1471-8 . %
Hyperglycemia, Infectious Complication and Mortality in Trauma Patients J Trauma 2004;56:1058-62. %
Effects of Hyperglycemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sternal Wound Infections in Diabetics undergoing Cardiac Surgery Ann Thorac Surg 1999;67:352-62 %  ** Statistically Significant
Intensive Insulin Therapy and Outcomes in SICU Patients N Engl J Med 2001;345:1359-67. %  ** Statistically Significant
Intensive Insulin Therapy and Outcomes in Mixed ICU Patients Mayo Clin Proc 2004;79:992-1000 * Statistically Significant
Intensive Insulin Therapy and Outcomes in MICU Patients N Engl J Med 2006;354:449-61 %  * Statistically Significant
Blood Glucose and Insulin Requirements during ICU Stay Crit Care Med 2003;31:359-66 mg/dL Units/h per cal/kg
Early versus Late Intensive Insulin Therapy in ICU Patients ** Statistically Significant Inten Care Med 2008;34:881-7
Hyperglycemia and mortality in VA ICU patients ,[object Object],[object Object],[object Object],[object Object],[object Object],ADA 2006 Scientific Sessions Medscape July 23, 2006
GluControl Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SCCM 2007 Scientific Sessions Medscape February 2007
What is the Optimal Glucose Range? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Optimal Glucose Target ,[object Object],[object Object],[object Object]
OSUMC Insulin Infusion Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Insulin Infusion Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Experience ** Statistically Significant %
Source of Dextrose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Nursing Hypoglyecmia Policy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Final Thoughts ,[object Object],[object Object],[object Object],[object Object],[object Object]

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Hyperglyceminin Icu Md2008