Nutr Res Pract.  2011 Oct;5(5):450-454.

Higher dextrose delivery via TPN related to the development of hyperglycemia in non-diabetic critically ill patients

Affiliations
  • 1Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul 120-752, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul 120-752, Korea. sokoh@yuhs.ac
  • 3Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.

Abstract

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 +/- 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9 +/- 7.1. The subjects received 2.3 +/- 1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: < 140 mg/dl vs > or = 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P = 0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.

Keyword

Hyperglycemia; dextrose; parenteral nutrition; critically ill; non-diabetic

MeSH Terms

APACHE
Blood Glucose
Critical Illness
Diabetes Mellitus
Glucose
Humans
Hyperglycemia
Intensive Care Units
Length of Stay
Linear Models
Nutritional Status
Parenteral Nutrition
Parenteral Nutrition, Total
Retrospective Studies
Blood Glucose
Glucose

Figure

  • Fig. 1 Amount of carbohydrate delivery via TPN and EN. We divided the subjects into two groups according to the mean blood glucose level during the first week of ICU care: < 140 mg/dl, normoglycemia group vs ≥ 140 mg/dl, hyperglycemia group. TPN, total parenteral nutrition; EN, enteral nutrition


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