Pour le choc septique, je pense qu'il est important de viser une glycemie normale donc je pense raisonnable de faire des gluco QID même si patient non diabetique. As-tu des études ou lecture à nous suggerer? Si tu poses la question, c'est sûrement parce que tu as lu ou entendu quelque chose là-dessus. En ce qui concerne les bolus d'insuline, je pense que cet article est pertinent.
THERAPY OF SEVERE DIABETIC KETOACIDOSIS: ZERO MORTALITY UNDER VERY-LOW- DOSE INSULIN APPLICATION Wagner, A., et al, Diab Care 22(5):674, May 1999 BACKGROUND: High-dose insulin therapy for diabetic ketoacidosis (DKA) was abandoned in the 1970s when "low-dose" insulin (5-10 U/h) was found to produce similar decreases in blood sugar while reducing the risk of hypokalemia. However, mortality from DKA continues to range between 5-10%. Preliminary experience has suggested that use of even lower doses of insulin may be safe and effective. METHODS: The authors of this prospective German study report on results achieved in 65 patients with severe DKA who were successfully managed with a protocol of very-low-dose insulin (0.5-4.0 U/h), with a target decrease in blood sugar of 50mg/dl/hr (2.77 mmol/hre). The patients were initially treated with small boluses of insulin (2-15 U), and 5% glucose was administered if the decrease in blood sugar exceeded 100mg/dl/h. Fluid replacement was initiated with Ringer's solution followed by normal saline or half-electrolyte solutions after measurement of serum electrolytes. Potassium supplementation was initiated at a rate of 10-20mmol/h if the initial serum potassium was below 4.5mmol/l. All patients received prophylactic heparin, and bicarbonate was given only for a pH below 7.0 with severe circulatory depression. RESULTS: The mean baseline blood sugar was 609mg/dl and the mean pH was 7.13. The patients exhibited a gradual improvement in blood sugar and metabolic parameters. Only five received bicarbonate for severe circulatory depression. Supplemental potassium was administered in 48 cases. No patient developed life-threatening complications and there were no deaths. CONCLUSIONS: The authors believe that infusion of very low doses of insulin with monitored electrolyte supplementation is a safe and effective approach to the treatment of severe DKA. 17 references Copyright 1999 by Emergency Medical Abstracts - All Rights Reserved 9/99 - #13 HYPERLINK "mailto:[EMAIL PROTECTED]"[EMAIL PROTECTED] HYPERLINK "mailto:[EMAIL PROTECTED]"martinphamdinh.googlepages.com _____ De : [email protected] [mailto:[EMAIL PROTECTED] De la part de Catherine Bich Envoyé : September 30, 2007 2:51 PM À : [email protected] Objet : URG-L: histoires de sucre Vous arrive-t-il de débuter,à lurgence ,de linsuline à hautes doses pour les cas de choc septique ?Voire même de septicémie sans choc trop trop évident ? Parlant sucre,donnez-vous encore un bolus dinsuline lors de linitiation de linsulinoTx dans les cas dacido-cétose ? C. No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 29/09/2007 9:46 PM No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.5.488 / Virus Database: 269.13.35/1039 - Release Date: 29/09/2007 9:46 PM
