Use of glucose-insulin-potassium (GIK) in human septic shock

Fifteen patients with septic shock and perfusion failure received a 20-min infusion of glucose-insulin-potassium (GIK, glucose 50%, 1 g/kg body weight; insulin 1.5 U/kg, potassium, 10 mMol) after volume loading and vasoactive medication had failed to eliminate hypotension and lactacidemia. Hemodynamic and oxygen measurements were obtained before, immediately and 30 min after GIK infusion. GIK improved hemodynamic status, at least temporarily, in 14 of 15 patients. Cardiac index (CI) increased simultaneously with an increase in cardiac filling pressure. Systemic vascular resistance decreased, particularly in patients with an initially low CI (less than 4 L/min X m2). Mean arterial and pulmonary artery pressures did not change. After 30 min, cardiac filling pressure fell while CI was still elevated, but this decrease was only significant for those with an initially low CI. Although arterial oxygen content decreased after GIK, oxygen consumption did not fall. Serum lactate increased. Six patients died because of ongoing sepsis. Nine patients survived at least 48 h, showing further clinical improvement. Only four patients were hospital survivors. Because GIK increased cardiac output and possibly oxygen consumption, its administration may be considered in the treatment of septic shock when conventional therapy fails.