Hypoglycaemia and Hyperglycaemia

Hypoglycaemia

Hyperglycaemia

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Hypoglycaemia

ICD-10 code: E10.0/E10.6/E11.0/E11.6/E12.0/E12.0/E12.6/E13.0/E13.6/E14.0/E14.6/E16.0/E16.1/E 16.2

Description

Hypoglycaemia, defined as a glucose concentration <4 mmol/L, is common in critically ill patients, and is associated with increased mortality. Risk factors associated with hypoglycaemia in critically ill patients include severity of illness, intensive/strict glucose control, continuous veno-venous haemodialysis, decreased nutritional feeds without adjustment of insulin infusions, prior diagnosis of diabetes mellitus, sepsis, and the need for inotropic support. See: Hypoglycaemia for further details.

General Measures

• Assess and treat precipitating factors.
• Maintain a target glucose concentration of 6-10 mmol/L.
• Monitor glucose every 15 minutes.
• Provide organ support (respiratory, cardiovascular, neurological).

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Medicine Treatment

If awake and alert:

• Glucose, oral, 20 g, immediately.
  • Alternatively, a carbohydrate-rich supplement may be given if tolerated.

If obtunded, or glucose level <2.5 mmol/L:

• Dextrose 50%, IV, 20 ml immediately.

If hypoglycaemia recurs or dextrose 50% IV solution is not available:

• Glucagon, SC, 1 mg immediately.

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Hyperglycaemia

ICD-10 code: E10.0-1/E11.0-1/E12.0-1/E13.0-1/E14.0-1/R73.9

Description

Hyperglycaemia (blood glucose concentration >11 mmol/L) occurs in up to 50% of critically ill patients (also called stress hyperglycaemia or critical illness hyperglycaemia). An elevated blood glucose in patients with previously undiagnosed diabetes and without significantly elevated glycated haemoglobin (HbA1c) levels (>6.5%) is suggestive of stress hyperglycaemia.

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Hyperglycaemia is associated with increased mortality, length of hospitalisation, and potentially an increased risk of hospital acquired infections.

See: Diabetic Ketoacidosis (DKA) And Hyperosmolar Hyperglycaemic State (HHS) for further details.

General Measures

• Maintain a glucose target in ICU: 6-10 mmol/L.
• Balanced salt solutions are preferred to normal saline for fluid resuscitation.
• Continuous insulin infusion therapy should be considered to achieve glycaemic targets.
• Risk of hypoglycaemia should be considered when choosing the method of insulin administration.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Adult Hospital _Chapter 23: Adult Critical Care_NEMLC Medicine Recommendations Review Cycle_ 2020_2023