2009 Southern Regional Meeting Abstracts

Purpose of Study: Critically ill patients with multiorgan failure may develop stress-related hyperglycemia (>140 mg/dL) even in the absence of diabetes. Regimented insulin therapy has been suggested to maintain serum glucose between 80-110 mg/dL in intensive care unit patients. An activation of the hypothalamic-pituitary-adrenal axis with elevated serum cortisol and catecholamines occurs in patients with decompensated, biventricular heart failure having hepatic and splanchnic (which includes the pancreas) congestion (DecompHF) and could contribute to hyperglycemia. It is presently uncertain whether nondiabetic patients hospitalized with DecompHF would have hyperglycemia on admission.
Methods Used: We retrospectively examined admission serum glucose in 41 patients without a history of diabetes, who were hospitalized at our urban medical center with DecompHF and whose clinical presentation included hepatic and splanchnic congestion, together with echocardiographic evidence of tricuspid regurgitation and distended inferior vena cava without respiratory variation. These patients were compared to 28 nondiabetic patients of whom 14 were hospitalized with acute left heart failure (LHF) and 14 with heart disease but no heart failure (HDNHF).
Summary of Results: Serum glucose (mean±SEM): DecompHF, 105.41±4.08 mg/dL; Acute LHF, 94.86±3.96 mg/dL; HDNHF, 124.57±11.72 mg/dL. Serum glucose exceeded 140 mg/dL in only 3 patients with DecompHF (144, 154 and 157 mg/dL).
Conclusions: In nondiabetic patients hospitalized with DecompHF that included hepatic and splanchnic congestion, serum glucose of >140 mg/dL was rarely seen on admission and when present was mild (<160 mg/dL). Hyperglycemia is also infrequent in nondiabetic patients hospitalized with acute LHF or HDNHF. The absence of hyperglycemia on admission calls into question the potential risk of hypoglycemia and associated adverse cardiovascular events that could accompany the empirical use of intensive insulin therapy in these patients.