Poremećaji metabolizma glukoze u bolesnika s akutnim koronarnim sindromom

Glucose metabolism disorders in acutely ill patients include oscillations in plasma glucose concentration outside the range of reference values. These disorders include both hyperglycemia and hypoglycemia, regardless of previous diagnosis of diabetes in a particular patient. Hyperglycemia is frequent in acute patients due to the increased release of stress hormones such as catecholamines and cortisol, but also as an effect of a cascade of proinflammatory cytokines in emergencies such as acute coronary syndrome, pulmonary edema, pulmonary embolism, injuries, severe infections and sepsis. Hyperglycemia occurs often even in patients in whom diabetes was not previously diagnosed, and in diabetic patients requirement for hypoglycemic medication may be temporarily increased. Hyperglycemia in cardiac emergencies is associated with more frequent adverse major cardiovascular events and worse prognosis. Hypoglycemia occurs seldom in these patients, its origin is almost always iatrogenic, and it worsens the patient’s prognosis even more than moderate hyperglycemia. Good regulation of glycemia is necessary in the management of these patients; therefore plasma glucose determination and close monitoring are obligatory, and therapy with short acting insulin should be introduced if plasma glucose concentration exceeds 10 mmol/L, regardless of the risk of hypoglycemia. It is also useful to determine the acid-base status and blood or urine ketones.Poremećaji metabolizma glukoze u akutnih bolesnika uključuju poremećaje poput hiperglikemije i hipoglikemije, odnosno odstupanja koncentracija glukoze u plazmi izvan referentnih raspona. Pritom je nevažno boluje li bolesnik od ranije dijagnosticirane šećerne bolesti. Hiperglikemija je česta kod ovakvih bolesnika zbog prolazno povišenih koncentracija kateholamina i kortizola, kao i niza proupalnih citokina, a može se javiti kod bolesti poput akutnog koronarnog sindroma, plućnog edema, plućne embolije, povreda, te teških infekcija i sepsa. Često se javlja kod bolesnika bez šećerne bolesti, kod dijabetičara može zahtijevati prolazno povišenje doza antidijabetičnih lijekova. Hipoglikemija se javlja mnogo rjeđe, po svom postanku je gotovo uvijek jatrogena. Hiperglikemija i hipoglikemija pogoršavaju prognozu akutnih bolesnika, te je u bolničkim uvjetima praćenje razine glukoze u krvi obvezno, uz uvođenje terapije kratkodjelujućim inzulinom kod hiperglikemije iznad 10 mmol/L. Dodatne informacije pruža određivanje acidobaznog statusa i ketona