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KMID : 1030220150160010025
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Journal of Korean Diabetes
2015 Volume.16 No. 1 p.25 ~ p.32
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Parenteral Nutrition Strategies for Achieving Glycemic Control in the Critical Care Setting
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Choi Soo-An
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Abstract
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Hyperglycemia commonly occurs in acutely ill patients who receive nutritional support, even those without a history of diabetes. A number of observational studies have identified hyperglycemia as a factor independently associated with poor outcome in various critically ill populations. Thus, glycemic control is an important component of metabolic management of the critically ill patient. Avoiding excessive calorie provision, especially carbohydrate calories, is one of the most obvious considerations for nutrition support regimens in terms of glucose control. In adult patients, carbohydrate provision is nearly always less than 4-5 mg/kg/minute. Also, providing lipid calories with parenteral nutrition (PN) helps to avoid excessive amounts of dextrose. There is evidence that, if the rate of lipid infusion remains low (less than 0.11 g/kg/hour), there is minimal risk of immunosuppressive effects. While avoidance of excessive total calories may be the most important aspect of managing nutrition during stress hyperglycemia, there may be some further advantage to hypocaloric feeding in some patients. Determining when to prescribe insulin is a key strategy in preventing hyperglycemia among patients receiving PN. Protocoldirected insulin dosing closely linking insulin to carbohydrate leads to better control of PN-induced
hyperglycemia than ad hoc inslin dosing strategies that rely heavily on supplemental insulin.
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KEYWORD
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Critical illness, Hyperglycemia, Hypoglycemia, Insulin, Parenteral nutrition
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