Insulin therapy in the pediatric intensive care unit

Faktor yang Berhubungan dengan Hiperglikemia dan Luarannya pada Anak Sakit Kritis

“…S akit kritis dapat memicu respons fase akut yang berhubungan dengan beberapa gangguan metabolik berat, meliputi hiperglikemia, dislipidemia, pemecahan protein yang berlebihan sebagai substrat untuk penyembuhan jaringan, serta sintesis protein fase akut dan glukosa di hati. [1][2][3] Respons stres metabolik akut antara lain ditandai dengan penglepasan sitokin dan sekresi hormon counter-regulatory, seperti katekolamin, glukagon, dan kortisol yang bekerja berlawanan dengan efek insulin. Hormon ini juga menyebabkan terjadinya glikogenolisis, glukoneogenesis, dan jalur metabolik lainnya, akhirnya menyebabkan hiperglikemia.…”

Supportive care for the critically ill neonatal foal

“…Hyperglycaemia is associated with non-survival in adult horses with acute abdominal disease (Hollis et al 2007) and occurrence of hyperglycaemia and requirement for insulin therapy were associated with non-survival in foals receiving parenteral nutrition (Krause and McKenzie 2007). In human medicine, the most frequently observed complication of insulin therapy is, sometimes severe, hypoglycaemia, particularly in neonates and children and it is currently unknown whether benefits will outweigh the risks associated with tight glucose control in this patient population (Verbruggen et al 2007). From a practical view, tight glucose control is associated with a significant increase in workload for the nursing staff and deviations from the protocol are common even in the point of face of vigorous monitoring (Malesker et al 2007).…”

“…Tight glucose control between 80-110mg/dl (4.4-6.1mmol/L) using intensive insulin therapy has been associated with decreased morbidity and mortality in critically ill human patients (van den Berghe et al 2001, Verbruggen et al 2007) and benefits and risks of this treatment strategy are currently much debated in human critical care. Hyperglycaemia is associated with non-survival in adult horses with acute abdominal disease (Hollis et al 2007) and occurrence of hyperglycaemia and requirement for insulin therapy were associated with non-survival in foals receiving parenteral nutrition (Krause and McKenzie 2007).…”

Zasady leczenia żywieniowego na oddziałach intensywnej terapii dziecięcej. Wspólne stanowisko towarzystw naukowych: Sekcji Anestezji i Intensywnej Terapii Dziecięcej PTAiIT, PTN, PTŻKD

“…In parenterally fed children, when the glucose concentration in serum exceeds 180 mg dL -1 , the infusion of insulin should be considered in an initial dose of 0.01-0.1 IU kg -1 h -1 . The dose is modified according to regularly monitored glycaemia [25,26]. In all of the treated patients, the glucose concentration should likely be maintained at < 180 mg dL -1 , and hypoglycaemia should be avoided [27].…”