Hyperglycemia in critical illness

Evidence that acute injury and critical illness can result in an elevation of blood glucose levels is not a new concept. However, the last decade has seen a rise in publications describing the potential harm of this unique form of hyperglycemia and the subsequent benefits of glucose control. More recently, the untoward effects of tightly controlling glucose concentrations in this setting have been more thoroughly elucidated. This has lead to a challenging clinical conundrum for practitioners both inside and outside of the intensive care unit. The latest guidelines attempt to shed light on this dilemma and provide guidance for practitioners. This article reviews the progression of the research, the multiple guidelines that have been published, and the clinical implications on the treatment of critical illness hyperglycemia, with particular focus on the emergency department.