Hypoglycemia in a Surgical Intensive Care Unit

Area of Science:

• Critical Care Medicine
• Endocrinology
• Surgical Patient Management

Background:

• Glycemic control is vital in critical care, as disruptions impact patient morbidity and mortality.
• Existing literature inadequately describes patients at high risk for hypoglycemia in surgical intensive care units (SICUs).

Purpose of the Study:

• To identify and characterize patients at high risk for hypoglycemia within a SICU setting.
• To delineate the specific patient populations most vulnerable to hypoglycemic events in surgical critical care.

Main Methods:

• A single-center, retrospective, observational study was conducted.
• Included SICU patients admitted between June 1, 2019, and July 31, 2020, who experienced at least one episode of hypoglycemia (blood glucose <60 mg/dL).

Main Results:

• Hypoglycemia occurred in 1.5% of SICU patients, with 41 events in 27 patients.
• Common diagnoses included cirrhosis, polytrauma, multisystem organ failure (MSOF), diabetes mellitus, and soft tissue infection.
• High-risk groups identified: MSOF (41%), nil per os (NPO) (37%), patients on long-acting subcutaneous insulin (11%), and continuous intravenous insulin infusions (11%).
• The majority of hypoglycemic events (59%) were iatrogenic, confirmed by multidisciplinary review.

Conclusions:

• Hypoglycemia is infrequent in surgical critical care but significantly associated with MSOF, NPO status, specific insulin therapies, soft tissue infections, and liver failure.
• Enhanced vigilance and frequent blood glucose monitoring in identified high-risk patients can mitigate hypoglycemia risk in the SICU.