Glucose metabolism disorders in patients with pulmonary embolism

Plućna embolija treći je najčešći uzrok smrtnosti od kardiovaskularnih bolesti. U najvećem broju slučajeva riječ je o komplikaciji duboke venske tromboze. To je životno ugrožavajuće stanje, koje je česta dijagnoza u hitnim ambulantama. Prezentira se različitom kliničkom slikom, a karakteristično bolovima u prsima, tahikardijom, tahipnejom i dispnejom. Plućna embolija može biti i potpuno asimptomatska, ali isto tako može uzrokovati i iznenadnu smrt. Postoje mnoge dijagnostičke pretrage koje pomažu u dijagnozi plućne embolije, ali je ključna MSCTA. Terapija se sastoji od antikoagulacije, reperfuzije i kardiopulmonalne potpore. Antikoagulantna terapija uglavnom uključuje niskomolekularni heparin i varfarin ili direktne oralne antikoagulantne lijekove. Uslijed akutnog nastupa plućne embolije dolazi do poremećaja u metabolizmu glukoze, koji se očituje kao stresna hiperglikemija. Riječ je o stanju privremenog povišenja glukoze u krvi u sklopu akutnog stresnog odgovora te se dijagnosticira rutinskom pretragom glukoze u plazmi. Još uvijek ne postoji univerzalna definicija granične vrijednosti glukoze koja bi označavala stresnu hiperglikemiju i optimalna terapija stresne hiperglikemije još nije utvrđena. Međutim, u većini slučajeva liječenje se temelji na nekom obliku inzulinske terapije. Stresna hiperglikemija je povezana s lošijim ishodima kod mnogih akutnih stanja pa tako i plućne embolije. Njeno se točno dijagnostičko i prognostičko značenje u plućnoj emboliji još uvijek istražuje.Pulmonary embolism is the third most common cause of death from cardiovascular diseases. In most cases it is a complication of a deep venous thrombosis. It is a life-threatening state that is often diagnosed in emergency rooms. It presents itself with various different clinical presentations, but characteristically with chest pain, tachycardia, tachypnea and dyspnea. Pulmonary embolism can also be completely asymptomatic, but it can also cause sudden death. There are many diagnostic methods that help diagnose pulmonary embolism, but the key method is MSCTA. The therapy consists of anticoagulation, reperfusion and cardiopulmonary support. Anticoagulant therapy mostly includes low-molecular-weight heparin and warfarin or direct oral anticoagulants. During an acute onset of pulmonary embolism there is a disruption in glucose metabolism that presents itself as a stress hyperglycemia. It is a transitory elevation of blood glucose that's part of an acute stress response and it is diagnosed with a routine plasma glucose test. A universally defined cut-off point for stress hyperglycemia still does not exist and the optimal therapy for stress hyperglycemia has not yet been determined. However, in most cases treatment is based on some form of insulin therapy. Stress hyperglycemia is associated with negative outcomes in many acute states as well as pulmonary embolism. Its diagnostic and prognostic value in pulmonary embolism is still being researched