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Hyperglycaemia in PICU

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Overview

Prolonged hyperglycaemia in PICU puts patients at increased risk of infection. Attempts to tightly control blood glucose have not reliably shown improvements in patient outcome and have resulted in an increased incidence of hypoglycaemia. Most post cardiac surgery patients have a transient rise in blood glucose that returns to normal within 6-12 hours. All adult ICUs and most PICUs do aim to keep blood glucose in a "reasonable" range though there is wide variation on what the upper limit if this range should be.

This guideline DOES NOT APPLY to patients with known or suspected diabetes mellitus.

Indication for treatment

Blood Glucose > 12 mmol/L for greater than 6 hours on 2+ consecutive measurements and not decreasing.

Treatment

  1. Ensure that the patient is not receiving excessive glucose.
  2. Prepare insulin infusion as per PICU guidelines.
  3. Start at 0.05units/kg/hr. DO NOT give a loading dose.
  4. Measure blood glucose hourly.
  5. Measure potassium 4 hourly.
  6. Stop infusion when blood glucose is < 10mmol/L.
  7. Increase infusion to 0.075 units/kg/hr if blood glucose either fails to decrease OR continues to increase over 2 hours. If the blood glucose remains elevated increase infusion rate to 0.1units/kg/hr. If blood glucose remains elevated at this rate of insulin infusion discuss with the PICU consultant.

Blood sugar < 3mmol/L

  • Stop insulin infusion if running.
  • Give glucose - 5ml/kg D10W as a push.
  • Recheck blood glucose 5 minutes after glucose given then Q30min until stable.

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Document Control

  • Date last published: 14 September 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Intensive Care Unit
  • Owner: D Buckley
  • Editor: John Beca
  • Review frequency: 2 years