Monitoring of Blood Glucose Level in Surgical Intensive Care Unit Patients with Sepsis

Abstract

Background: Sepsis now is defined as evidence of infection plus life-threatening organ dysfunction, clinically characterized by an acute changes of 2 points or greater in the SOFA score. The new clinical criteria for septic shock include sepsis with fluid-unresponsive hypotension, serum lactate level greater than 2mmol/L, and the need of vasopressor to maintain mean arterial pressure of 65mmHg or greater. One of the most important metabolic changes in sepsis is hyperglycemia arising from muscle glycolysis and lipolysis, and subsequent gluconeogenesis and glycolysis in the liver. The other feature of metabolic changes in sepsis is hyperlactatemia due to glycolysis in muscle caused by counter regulatory hormones and cytokines. Gcontrol to a moderately tight range (140-200mg/dl) is not inferior to euglycemia and clearly safer in critically ill patients. Aim of Study: The aim of this study is monitoring of blood glucose level in Surgical Intensive Care Unit patients with sepsis. Patients and Methods: This study was carried out in Tanta University Hospitals at Surgical Intensive Care Unit (SICU) for six months (from October 2017 to March 2018) after a written informed consent was obtained from the patients relatives, 100 patients of both sex admitted to SICU suffering from sepsis were enrolled in the study. Everyone had a secret code number. Results: Our results showed that no significant correlation between C-Peptide level & RBS in hyperglycemic patients, –ve significant correlation between C-Peptide level & RBS in hypoglycemic patients, significant decrease in MAP of hypoglycemic cases more than hyperglycemic cases, significant increase in HR of hyperglycemic cases more than hypoglycemic, significant increase in mortality in hypoglycemic patients as compared to hyperglycemic patients. Conclusion: We concluded that frequent blood glucose measurement is one element of the routine intensive monitoring that all critically ill patients receive following admission to intensive care units. Transient increase in blood glucose concentration (hyperglycemia) is very common in this patient. Although decrease in blood glucose concentration (hypoglyCorrespondence to: Dr. Abdullah N. El-Oraby, The Department of Anesthesiology, Faculty of Medicine, Tanta University cemia) is rare but has very bad prognosis with significant increase in mortality rate.