Managing Hypoglycemia & Hyperglycemia Critical Care

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Managing Hypoglycemia & Hyperglycemia Critical Care

  1. 1. Managing Hypoglycemia & Hyperglycemia
  2. 2. RISK FACTORS <ul><li>HYPOGLYCEMIA </li></ul><ul><li>HYPERGLYCEMIA </li></ul><ul><li>Diabetes </li></ul><ul><li>Medication Adverse Effects </li></ul><ul><li>Medication Interactions </li></ul><ul><li>Continuous Renal Replacement Therapy </li></ul><ul><li>Sepsis </li></ul><ul><li>Nutrition Imbalance </li></ul><ul><li>Diabetes </li></ul><ul><li>Medication Adverse Effects </li></ul><ul><li>Medication Interactions </li></ul><ul><li>Sepsis </li></ul><ul><li>Stress Induced </li></ul><ul><li>Nutrition Imbalance </li></ul>
  3. 3. Effective glucose control in the intensive care unit (ICU) has been shown to decrease morbidity across a large range of conditions and also to decrease mortality (IHI,2009).  
  4. 4. TIGHT GLYCEMIC CONTROL IN CRITCALLY ILL ADULTS <ul><li>Target range is 80-110 </li></ul><ul><li>Hyperglycemic patients are started on a Regular Insulin drip titrated depending on blood glucose levels. </li></ul><ul><li>Blood glucose levels are check every hour </li></ul><ul><li>Each institution has a protocol with guidelines for titration </li></ul>
  5. 5. Managing Hypoglycemia <ul><li>Blood glucose less than 70 or per hospital policy/protocol </li></ul><ul><li>First assess the patient to see if they exhibit symptoms ex: change in mental status, irritability. </li></ul><ul><li>Medication usually given are: </li></ul><ul><li>1. Orange juice orally followed by a snack </li></ul><ul><li>2. Glucagon IM or IV </li></ul><ul><li>3. Dextrose 50% IV (most common in ICU) </li></ul>
  6. 6. Managing Hyperglycemia <ul><li>PRN sliding scale with fast acting Regular or Aspart insulin is used mostly for Diabetics Ex. If blood glucose 200-249 Give 2 units Regular insulin SQ </li></ul><ul><li>Longer acting insulin (NPH, Levemir, Lantus) is usually administered daily </li></ul><ul><li>For tight glycemic control or critically abnormal high (>400) glucose levels, continuous Regular insulin IV is given </li></ul>
  7. 7. REVIEW <ul><li>Hypoglycemia is a priority issue and is mostly managed with D50 IV </li></ul><ul><li>Hyperglycemia is equally important and is managed with insulin. </li></ul><ul><li>Only regular insulin is administered IV </li></ul><ul><li>It’s important to monitor blood glucose levels as well as assess the patient. </li></ul>

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