Il parait (on m'avait dit ça vers ...1978... ) que les petites doses d'insuline de l'ordre de 1 Unité /heure dans l'acidocétose diabétique suffisent à bloquer la cétogénèse. ----- Original Message ----- From: Martin Pham Dinh To: [email protected] Sent: Monday, October 01, 2007 1:03 AM Subject: URG-L: histoires de sucre
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 [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 l'urgence ,de l'insuline 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 d'insuline lors de l'initiation de l'insulinoTx dans les cas d'acido-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
