Haemodialysis, nutritional disorders and hypoglycaemia in critical care

Br J Nurs. 2017 Mar 9;26(5):281-286. doi: 10.12968/bjon.2017.26.5.281.

Abstract

This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.

Keywords: Critical care; Glucose; Hypoglycaemia; Simplified Acute Physiology Score.

MeSH terms

  • APACHE
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Catecholamines / therapeutic use*
  • Cohort Studies
  • Comorbidity
  • Critical Illness / epidemiology*
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / epidemiology
  • Enteral Nutrition
  • Female
  • Glucose / therapeutic use
  • Hospital Mortality
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / epidemiology*
  • Hypoglycemic Agents / adverse effects*
  • Incidence
  • Insulin / adverse effects*
  • Intensive Care Units
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Nurses
  • Parenteral Nutrition
  • Renal Dialysis*
  • Retrospective Studies
  • Risk Factors
  • Vomiting
  • Workload / statistics & numerical data
  • Young Adult

Substances

  • Catecholamines
  • Hypoglycemic Agents
  • Insulin
  • Glucose