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2004, Número 6

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Cir Cir 2004; 72 (6)


Hiperglucemia en pacientes graves y en estado crítico. Implicaciones clínicas para su tratamiento

Miranda-Ruiz R, Castañón-González JA

Idioma: Español
Referencias bibliográficas: 70
Paginas: 517-524
Archivo PDF: 74.46 Kb.


RESUMEN

La hiperglucemia es un hallazgo frecuente durante la etapa de estrés que acompaña al enfermo grave y en estado crítico; a menudo se percibe como parte de la respuesta metabólica de adaptación paralela al curso clínico de la enfermedad aguda. Se asocia a mayor frecuencia de infecciones nosocomiales, y en los pacientes con infarto agudo del miocardio o evento vascular cerebral agudo aumenta la morbilidad y mortalidad. Sólo la tercera parte de los pacientes que presentan hiperglucemia en la unidad de cuidados intensivos tiene diabetes mellitus. Se acepta como norma general que la hiperglucemia durante esta condición de estrés debe tratarse con insulina sólo cuando la glucemia es igual o mayor a 200 mg/dl. Recientemente se demostró en pacientes en estado crítico que mantener la glucemia entre 80 y 110 mg/dl mediante un tratamiento intensivo con insulina intravenosa disminuye la morbilidad y mortalidad de forma significativa. Aunque este tratamiento intensivo incrementa el riesgo de hipoglucemia, estos episodios no provocan consecuencias clínicas adversas. Si se mantiene la glucemia en límites normales los pacientes presentan una mejoría notoria. Se postula que la hiperglucemia es un factor que favorece la respuesta pro inflamatoria, mientras que la insulina participa de manera activa en la respuesta antiinflamatoria. Con base en estas evidencias se recomienda que la hiperglucemia que desarrollan los pacientes durante el estrés agudo debe tratarse y mantenerse en límites normales independientemente de que tengan o no diabetes mellitus.


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