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lüll Hyperglycemia in critical illness: a review Brealey D; Singer MJ Diabetes Sci Technol 2009[Nov]; 3 (6): 1250-60Hyperglycemia is commonplace in the critically ill patient and is associated with worse outcomes. It occurs after severe stress (e.g., infection or injury) and results from a combination of increased secretion of catabolic hormones, increased hepatic gluconeogenesis, and resistance to the peripheral and hepatic actions of insulin. The use of carbohydrate-based feeds, glucose containing solutions, and drugs such as epinephrine may exacerbate the hyperglycemia. Mechanisms by which hyperglycemia cause harm are uncertain. Deranged osmolality and blood flow, intracellular acidosis, and enhanced superoxide production have all been implicated. The net result is derangement of endothelial, immune and coagulation function and an association with neuropathy and myopathy. These changes can be prevented, at least in part, by the use of insulin to maintain normoglycemia.|*Critical Illness[MESH]|Animals[MESH]|Blood Glucose/drug effects/*metabolism[MESH]|Critical Care[MESH]|Dietary Carbohydrates/adverse effects[MESH]|Epinephrine/adverse effects[MESH]|Humans[MESH]|Hyperglycemia/blood/diagnosis/*etiology/prevention & control[MESH]|Hypoglycemia/blood/diagnosis/etiology[MESH]|Hypoglycemic Agents/administration & dosage/adverse effects[MESH]|Insulin Resistance[MESH]|Insulin/administration & dosage/adverse effects[MESH]|Risk Assessment[MESH]|Risk Factors[MESH] |