Effects of Hyperglycemia on Neurologic Outcome in Stroke Patients

Alison S. Paolino; Krista M. Garner

Disclosures

J Neurosci Nurs. 2005;37(3):130-135. 

In This Article

Hyperglycemia Risk Factors

Hyperglycemia as a manifestation of the stress response is most evident after an ICU admission and may resolve as the underlying catabolic illness subsides (McCowen et al. 2001). Multiple factors have been associated with an increased risk of hyperglycemia in critical illness, including frequent administration of exogenous dextrose through intravenous drip, intravenous medications and antibiotics in dextrose solutions, glucocorticoid medication, catecholamine vasopressors, total parenteral nutrition administration (TPN), as well as increased age and prolonged bed rest. Table 1 lists the risk factors associated with the development of hyperglycemia in acute, critical illness. Some patients, particularly those with an untreated underlying process such as infection or ongoing injury, may demonstrate persistent metabolic disregulation and continued hyperglycemia (McCowen et al., 2001).

Bed rest alone in the absence of critical illness is associated with reduced skeletal muscle insulin sensitivity (McCowen et al., 2001). Stuart, Shangraw, Prince, Peters, & Wolfe (1988) found that 6 days of strict bed rest in healthy volunteers resulted in moderate deterioration in oral glucose tolerance and increased fasting plasma insulin concentration and insulin response to oral glucose challenge by more than than 40%.

Aging is associated with a higher incidence of stress hyperglycemia (McCowen et al., 2001). It is suggested that elderly people mount an inadequate response to the insulin resistance of critical illness, which is produced by the actions of increased counterregulatory hormones and cytokines (McCowen et al., 2001). In a study by Frankenfield, Cooney, Smith, & Rowe (2000), trauma patients older than 60 years of age had a 38% incidence of hyperglycemia, compared with a 0% incidence in younger patients with similar carbohydrate intake.

An often-overlooked risk factor for hyperglycemia in critically ill patients is the use of dextrose in excess amounts. High concentrations of dextrose are found in multiple sources in hospitals, such as in dialysis solutions, intravenous medications, and TPN. In an analysis of stress hyperglycemia in nondiabetic patients receiving TPN, participants who received dextrose at rates higher than 4 mg/kg/min had a 50% chance of developing hyperglycemia (Schloerb & Henning, 1998).

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