Abstract

ASUS, Nazarena et al. Hyperglycemia in Neurocritical patients. Diaeta [online]. 2015, vol.33, n.150, pp.07-11. ISSN 1852-7337.

Introduction. The neurocritical patient develops a response to hipermetabolic and hipercatabolic injury. In such circumstance, there is an increase in glycemia as a result of the insulin resistance typical of the metabolic stress. Hyperglycemia in these patients is associated with increased morbidity and mortality. Theoretical framework. Brain activity requires a high energy consumption, mainly using 30% of plasma glucose. The supply of glucose must be continuous, as the brain has no reserves. The gradient between brain and plasma glucose values is 110- 126 mg/dl, suggesting wider cut points in glycemic control in these patients. It has been observed that a drastic reduction in blood glucose due to strict controls (<110 mg/dl) favors an increase in the relation lactate-pyruvate and glutamate of the brain, thus increasing brain damage. Argumentation. Various arguments for strict control of blood glucose (<110 mg/dl) versus conventional management (<180 mg/dl) are presented. Higher incidence of mortality associated with hypoglycemia by strict controls with intensive insulin therapy was observed. The American Dietetic Association (ADA) recommends that for critical patients the glucose level should be between 140 and 180 mg/dl; in this point the American and European guidelines coincide. Conclusion. Since study findings suggest that the goal of normoglycemia would not necessarily benefit the patient and could be detrimental, the current publications do not recommend the use of low glycemic goals in neurocritical patients.

Keywords : Neurocritical; Diabetes; Blood glucose; Insulin; Adult.

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