MICU/SICU - why open heart patients have high blood sugar?

[telefloornurse]

i can't find it in the internet

a little help please

[EricJRN, MSN, RN]

Check out the link below (especially the second page, under Introduction) which explains more about the mechanisms of stress hyperglycemia.

http://www.surgicalcriticalcare.net/Guidelines/glucose_control.pdf

[NaomieRN]

My opinion: Maybe it is because of high sugar they have the open heart surgery to begin with.

In the heart muscle of type 1 diabetics, high blood glucose is a significant contributor to poorly opening vessels, or poor vasodilation, according to a study by researchers at Washington University School of Medicine in St. Louis. Even administration of high levels of insulin, which usually enhances vasodilation, can't counteract the negative effect of high glucose on the heart.

[dawngloves, BSN, RN]

Thanks Eric. Just yesterday we were having a discussion at work as to whether PICC placement would be the cause of hyperglycemia in a neonate an hour later.Still not sure if that was it, but the article makes for good argument.

[telefloornurse]

hi everyone

i found a site on the internet that says the reason ppl have high blood sugar level after heart surgery was that the body's way of metabolism using the fat in the fat storage.

i lost the web site

thanks anyway

[EricJRN, MSN, RN]

Of course the strange thing about all of this is that we have stress hyperglycemia, but we could just as easily see stress hypoglycemia in a lot of patients, esp neonates, if they have an issue where their glucose utilization goes up (temp issues, hypoxia, etc).

[dawngloves, BSN, RN]

Of course the strange thing about all of this is that we have stress hyperglycemia, but we could just as easily see stress hypoglycemia in a lot of patients, esp neonates, if they have an issue where their glucose utilization goes up (temp issues, hypoxia, etc).

Being this was a DOL 1 25 weeker all those came up. Plus someone had to throw head bleed into consideration. Could have been anything.

Anyway, not to go too far OT, in post CABG pts you need to dig a little deeper into the hypoglycemia as it could be anything as well. Pt hx, infection, stress.Look at the big picture.

[my2sons]

Stress response, drips, and drugs. Epinephrine frequently causes hyperglycemia, as do some iv steroids commonly used for lung problems.

[Ann RN]

:heartbeat :heartbeat post cardiac surgery patients frequently have "catecholamine surges" causing sudden release of epinephrine & norepinephrine. this in turn causes the high blood sugars.

[ceska2]

Any sort of bodily trauma results in glucose release. Coming off pump is hard on kidneys and pancreas especially. Temporary decrease in pancreatic insulin production causing higher blood sugars. Having diabetes will obviously result in a higher sugar.

[augigi, CNS]

I wonder if you read the internet article correctly - generally, hyperglycemia increases fatty acid metabolism, and not vice versa?

Bottom line is it doesn't matter why the hyperglycemia, so much as that it is controlled quickly and strictly - there are a lot of data about worse outcomes with high sugars, regardless of prior diabetes.

[Amalia]

Hey! I work with CABG patients in Denmark. I have learned that patients who have been on the heart and lungmachine during operation especially develops hyperglycemia. The reason is that some bloodcells get destroyed in the machine and this results in SIRS and a large stressrespons. These patients develops insulinresistence, catabolism and glucagon release. It also results in a disturbance in the bloodclotting and can develop DIC.