Pharmacotherapy Considerations in Hospitalized Patients With COVID-19 Pneumonia

William Pruett, MD; Lee E. Morrow, MD, MSc, FCP, FCCP, FCCM, ATSF; Mark A. Malesker, PharmD, FCCP, FCCP, FCCM, FASHP, BCPS


US Pharmacist. 2020;45(44020):HS9-HS16. 

In This Article

Glycemic Control

Hyperglycemia is common in critically ill COVID-19 patients.[8] The etiology appears to be multifactorial and potentially includes a combination of viral destruction of beta islet cells decreasing endogenous insulin release; insulin resistance; stress-induced hyperglycemia; and steroid-induced hyperglycemia.[25] Although some experts have suggested placing all critically ill patients with hyperglycemia on an insulin drip, this results in more nursing time in the infected patient's room (checking blood sugars frequently and titrating the drip) and attendant PPE consumption while also substantially increasing the daily fluid volume administered. Accordingly, many clinicians prefer a subcutaneous insulin regimen typically combining an intermediate- or long-acting agent with a sliding-scale short-acting agent. Regardless of the combination used, the pharmacist should assist in ensuring that a blood sugar level of 140 to 180 mg/dL is targeted.[26]