Abstract TP338: Process Improvement Retrospective Review: Hyperglycemia Treatment after Stroke and Subsequent Hypoglycemia
Background and Purpose: Admission blood glucose in stroke patients has been proven to be an independent predictor of disability and short term mortality. Hyperglycemia has been shown to have an association with infarct volume expansion in ischemic stroke patients. Euglycemia is often achieved through the use of an intravenous insulin drip. Current guidelines caution against the use of D5W as the excess free water may exacerbate cerebral edema; rather, normal saline is preferred. The use of IV insulin with normal saline or other non-dextrose containing IV fluids without enteral nutrition has been the subject of concern for increased hypoglycemic episodes.
Methods: Single center review of all patients admitted for all types acute stroke from May 1st, 2011 to April 27th, 2012 who were subsequently placed on an IV insulin drip at any time during hospitalization (n=97). Retrospective review of all hypoglycemic episodes (<70mg/dL), IV maintenance fluids, and nutrition (tube feeding, oral diet, TPN) during the course of hospitalization was conducted.
Results: A total of 97 stroke patients on IV insulin were identified; 20 (20.6%) were excluded due to alternately receiving dextrose and non-dextrose containing fluids; 65 (67%) did not receive any IV fluids containing dextrose while on IV insulin; 12 (12.4%) did receive IV fluids containing dextrose. The number of patients who experienced hypoglycemia was not significantly different between groups [5 (7.7%) vs. 0 (0%), p=1.000]. In the 5 patients with hypoglycemic episodes 4 were receiving enteral feeding during these episodes; only 1 patient in the sample (1.3%) was on neither IV dextrose nor enteral nutrition during a hypoglycemic episode.
Conclusions: Post-stroke hyperglycemia is safely controlled by IV insulin and non-dextrose containing solutions without significant risk for hypoglycemic episodes.
- © 2012 by American Heart Association, Inc.