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Do you know anything about whether blood sugar levels rise shortly after respiratory & circulatory failure?

Yesterday one of my supervisors said he once measured the blood sugar of a patient to 30 shortly after he went into cardiac arrest, how could this be?

Marc

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How do you do this? How many TAAs have you seen? In what percentage of the times that you thought you saw a TAA were you right? In what percentage were you wrong? How many patients have you evalua

Aside from what has already been stated, you might want to do some reading on “stress hyperglycemia”. This is relatively common with cardiac failure/AIM, or any other acute injury/stress state for tha

I totally understand crotchity's point... when your not sure, just give drugs until something happens Good lessen for the younger generation eh?

Do you know anything about whether blood sugar levels rise shortly after respiratory & circulatory failure?

Yesterday one of my supervisors said he once measured the blood sugar of a patient to 30 shortly after he went into cardiac arrest, how could this be?

Marc

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Ok does that make any logical sense to you ?

I have no idea, that's why I am asking. I heard some talk about it yesterday and it piqued my curiosity.

Thirty what? Mmol? Mg/dL?

mmol.

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Your asking many questions .. in one sentence.

1- Ok so just how in an arrest with no forward blood flow could blood glucose levels be raised ?

Prior to an arrest in CVA MI or trauma the human body will in compensate for the increased physiological requirements, (cortisol and gluconeogenesis) but is that measurable in the field on the dip stick ...hmmm, not likely.

2- If it were a respiratory failure and typically extremely high metabolic demands due to WOB "work of breathing" and depleted glucose stores the reading would be lower, this makes logical sense, does it not ?

3- 30 mmol/L (that's 545.454 mg/ dl would be rather high, did the supervisors patient arrest due to a Hyperosmolar Hyperglycemia and buddy supervisor is basing his "observation" on that anecdotal finding alone ?

Here is some links for your reading pleasure and further educational needs:

http://emedicine.med...914705-overview

http://en.wikipedia....aboratory_tests

<edit spelling again>

Edited by tniuqs
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Aside from what has already been stated, you might want to do some reading on “stress hyperglycemia”. This is relatively common with cardiac failure/AIM, or any other acute injury/stress state for that matter…need not have a history of diabetes

Wiki has a brief article about it http://en.wikipedia.org/wiki/Stress_hyperglycemia

Without going through the exact mechanisms (mainly to do with increased immflamatory response), the sugar levels can actually be an indication of patient mortality, that is, the higher the sugar the worse patient outcome. Check out the article below…very interesting results relating to the BSL and patient mortality.

http://www.jstage.jst.go.jp/article/circj/70/8/1064/_pdf

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An excellent find have learned something today

I do remain sceptical about elevated BGL in any arrested patient for any length of time, this will undoubtedly result in decreased BGL, due cellular metabolism, complicated by anaerobic respiration, lactic acid production +++. besides I am under the impression (could be wrong) there are accuracy limits when typical BGL evaluation in regards to PH.

We have come a long way from drop the blood on a stick, wait a certian time and compare &quot;colours&quot; to now with jump drives that do record keeping graphs and spread pages.

This topic has really piked my interest in regard's to delivering hypoglycemic agents at the critical care level in the field during cardiogenic shock. If cardiogenic shock is being treated and hyperglycemia is documented. I will now be doing BGL on all Chest Pain even if no IDDM is the history, I did not in past. I have been doing bedside troponin as a diagnostic guide and am pushing to get these on car in my hood.

Evidence Based Medicine now entrenched in EMS / AHA these day, this study is suggesting that their is a decreased morbidity mortality. Could this study be pointing the way for improved delivery of pre-hospital care ? That said, the study is a prognosis indicator and not if relative hyperglycemia &quot;treated&quot; reduces mortality, (from what I read) then of course funding for a study in EMS .... hmm well ..... not a lot of cash for that these days.

Second thought getting into the books / studies, the increase in blood glucose is marginal (~ 9.2 ) to be using a typical insulin sliding scale (yup and controversy there too) as the sliding scales are used in know IDDM only, then, giving insulin SQ with decreased perfusion. Well it could be more more complex for my lil bean. Historically insulin has not been used to treat hyperglycemia in EMS, bucking the old school could be an issue as well.

Perhaps other hypoglycemics could be trialled, maybe worth some time in a follow up with a researcher. I know one a few doing transplants with islets of langerhan in livers at the University Hospital in Edmonton and having great success.

cheers

Edited by tniuqs
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Just did a bit more reading today, as far as the evidence based stuff is concerned, treating with insulin isn't yet a standard practice, but may have its benefits. I think some of the intensivists/ED physicians down my way treat stress hyperglycemia, but definitely isn't a norm as far as I know. Also, I think there are still some issues regarding whether or not the sugar actually causes harm or if it's just an indicator.

From personal experience I can recall one recent cardiogenic shock patient, initially with a BSL of 9mmol or so, on arrival to emerg about 30mins later who had a BSL of 20+...needless to say he followed the trend

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Hmm sad to hear re your patient..

I see your point about a predictor vs is treating hyperglycemia and outcomes .. I think that cortisol levels do have a lot of direct influence (most honestly its beyond my pay grade) that said this innocent query has really got me looking again, so thumbs up to the OP for asking what initially perceived was a benign question "in my view" live and learn.

jstalmm .. I see your relatively new to EMT City ... so a hearty Welcome, it appears from your post you have some very valid things to contribute, I would encourage yourself to participate more often.

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