Pérez PA, Delfín RR

Idioma: Español
Referencias bibliográficas: 18
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RESUMEN

Objetivo: Determinar la eficacia de la infusión de insulina a dosis bajas en el manejo del estado hiperosmolar hiperglicémico (HHS). Diseño: Reporte de casos. Lugar: Servicio de Urgencias de un hospital de atención de tercer nivel, Veracruz, Veracruz; México. Pacientes y métodos: Se incluyeron 20 pacientes con estado hiperosmolar divididos en dos grupos: 1) infusión de insulina rápida a 0.1 UI/kg/h, 2) esquema de insulina dependiendo de glicemia capilar con el esquema siguiente: 180 = 4 UI, 240 = 8 UI, más de 400 = 10 UI. Se realizaron mediciones de glucemia central, osmolaridad, mediciones hemodinámicas, estado neurológico al ingreso a las 2 y 8 h. El análisis estadístico fue realizado con la prueba de t de Student. Resultados: A las 8 h el grupo 1 tuvo una glucemia sérica de 293 mg/dL, glucemia capilar de 271 mg/dL, sodio de 142 mmol/L, osmolaridad de 301 mmol/kg, en comparación con el grupo 2: glucemia sérica y capilar de 506 mg/dL y 442 mg/dL respectivamente, sodio 153 mmol/L y osmolaridad 345 mmol/kg (p ‹ 0.01). Conclusión: La infusión con dosis bajas de insulina permite es más efectiva que el uso de dosis fraccionadas de insulina en la recuperación de los pacientes con estado hiperosmolar no cetósico.

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