HyperglycemiaDRG CategoT 463

Mean LOS: 4.5 days Description: MEDICAL: Signs and Symptoms with CC

I I yperglycemia exists when the blood glucose level is greater than 110 mg/dL. Normal blood glucose levels can be maintained between 70 and 110 mg/dL when there is an adequate balance between insulin supply and demand. In acutely ill individuals, hyperglycemia is usually not diagnosed until a random test of serum glucose level shows an increase above the 150 to 200 mg/dL range. Glucose is the most important carbohydrate in body metabolism. It is formed from the breakdown of polysaccharides, especially starch, and is absorbed from the intestines

440 Hyperglycemia into the blood of the portal vein. As it passes through the liver, glucose is converted into glycogen for storage, but the body maintains a blood level for tissue needs.

Insulin is produced by the beta cells of the pancreas, which are stimulated to release it when the blood glucose level rises. Insulin transports glucose, amino acids, potassium, and phosphate across the cell membrane. Insufficient production or ineffective use of insulin causes an elevated blood glucose level (hyperglycemia), which promotes water movement into the bloodstream from the interstitial space and intracellular fluid compartments. As blood glucose levels increase, the renal threshold for glucose reabsorption is exceeded, and glycosuria (loss of glucose in the urine) occurs. Glucose in the urine acts as an osmotic diuretic, and the patient has an increased urinary output in response that can lead to a serious fluid volume deficit. As glucose levels climb, the blood becomes more viscous and the patient is also at risk for thromboembolic phenomena.

Insulin resistance and hyperglycemia has been linked with any critical illness or traumatic injury, and has been named the "diabetes of injury." Current research has found links between hyperglycemia and poor outcomes from acute illnesses and trauma. Current thinking is that with better control of hyperglycemia, patient outcomes may improve during an acute illness.

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