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Colegio de Medicina Interna de México.

2013, Número 2

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Med Int Mex 2013; 29 (2)


Hiperglucemia por estrés

Calvo-Colindrez JE, Duarte-Mote J, Lee Eng-Castro VE, Espinosa-López RF, Romero-Figueroa S, Sánchez-Rojas G

Idioma: Español
Referencias bibliográficas: 44
Paginas: 164-170
Archivo PDF: 290.39 Kb.


RESUMEN

La hiperglucemia por estrés es la que surge en pacientes ingresados a las unidades de cuidados intensivos con valores previos de glucosa normal. La hiperglucemia es común en pacientes con enfermedades catabólicas, en quienes empeora su pronóstico. En los pacientes quirúrgicos la hiperglucemia se asocia con riesgo creciente de complicaciones infecciosas; la evidencia indirecta indica que el mantenimiento de un estado euglucémico disminuye el riesgo de infección. Las causas de la hiperglucemia por estrés incluyen: concentración excesiva de hormonas contrareguladoras (glucagón, hormona de crecimiento, catecolamina y glucocorticoides endógenos o exógenos), tisulares o plasmáticas de citocinas (particularmente factor alfa de necrosis tumoral [TNalpha] e interleucina-1). Los pacientes con apoyo alimenticio excesivo, sobre todo intravenoso, son particularmente propensos a la hiperglucemia. La insulina sigue siendo el patrón de referencia en el tratamiento de la hiperglucemia, aunque la evidencia que documenta la ventaja clínica de la terapia agresiva de la insulina en las unidades de cuidados intensivos es escasa, sí ha resultado benéfica para los pacientes quirúrgicos tratados en unidades de cuidados intensivos.


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