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Fluids & Electrolytes
At a landmark endocrinology conference in December, experts called for standardized blood glucose guidelines for all hospitalized patients. From an examination of the evidence, they identified a direct link between high blood glucose levels and longer hospital stays, infection and other complications, and mortality rates. For example, an analysis of 15 studies revealed that following myocardial infarction, hyperglycemia (blood glucose levels above 110 mg/dl) increased heart failure and death in patients with both diagnosed and undiagnosed diabetes. Another study showed a 57% reduction in deaths for hyperglycemic patients who received intravenous (I.V.) insulin for 3 days after cardiac surgery.
The following recommendations were proposed at the conference.
* Blood glucose levels should be maintained below 110 mg/dl in all patients receiving intensive care.
* For patients not receiving intensive care, premeal blood glucose levels should be no higher than 110 mg/dl, and maximum levels after eating shouldn't rise above 180 mg/dl.
* For pregnant women in prelabor, the premeal blood glucose level should be 100 mg/dl; an hour after a meal, it should be 120 mg/dl or less.
The preferred treatment for hyperglycemia in a hospitalized patient is I.V. insulin, but some clinicians are reluctant to use it for fear of triggering hypoglycemia. Arguing that hypoglycemia can be easily detected and treated in a hospital, these experts say the benefits of insulin far outweigh the risks.
For the full consensus report from the American College of Endocrinology and the American Association of Clinical Endocrinologists (AACE), visit AACE's Web site at http://www.aace.com and select "publications," then "consensus conferences."
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