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Hyperglycaemia and neurological injury
1Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK.
Current Opinion in Anaesthesiology
|September 12, 2008
Summary
Hyperglycaemia worsens neurological injury outcomes. While tight blood glucose control is beneficial, it risks hypoglycemia, which can also harm the brain. Therefore, slightly less strict glucose control is advised for neurological injury patients.
Area of Science:
- Neurology
- Critical Care Medicine
- Endocrinology
Background:
- Hyperglycaemia is known to lower the ischaemic neuronal threshold.
- Elevated blood glucose levels can worsen neurological outcomes following trauma, stroke, and subarachnoid haemorrhage.
Purpose of the Study:
- To review and appraise the evidence supporting tight glycaemic control in patients with neurological injury.
- To evaluate the benefits and risks of intensive insulin therapy in this patient population.
Main Methods:
- Systematic review of clinical and experimental data.
- Analysis of studies investigating glycaemic control strategies in neurological injury.
Main Results:
- Hyperglycaemia adversely affects outcomes in critically ill patients.
- The benefits of intensive insulin therapy for neurological injury are unclear and may be offset by increased hypoglycaemia.
- Hypoglycaemic episodes can aggravate neurological injury.
Conclusions:
- While controlling hyperglycaemia in neurological injury is sensible, it must consider the risk of detrimental hypoglycaemia.
- Slightly less stringent blood glucose control may be preferable in patients with neurological injury compared to critically ill patients without neurological injury.
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