الفهرس 
Pathophysiology of stress hyerglycemiaOnly 14 pages are availabe for public view
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Abstract
Stress hyperglycemia is defined as any glucose value
>7.8 mmol/l (140 mg/dl) in patient without previous history of diabetes mellitus.
For a long time, it was believed that a mild degree of hyperglycemia would be beneficial for organs
that largely rely on glucose for energy provision they only treating excessive hyperglycaemia above
the renal threshold (>220 mg/dl) it called standard care.
Since 2001 With the publication of the first, landmark Leuven study on intensive insulin therapy in
adult surgical critically ill patients this concept was challenged. This approach (standard care)
was compared with ‘intensive insulin therapy’ (achieving normal fasting blood glucose levels (80-
110 mg dl-) with insulin infusion), intensive insulin therapy strikingly lowered mortality in-ICU
and in hospital, most pronounced for long-stay patients, and improved long-term outcome.
Our study was done to assess the early outcome of tight glycemic control in comparison to
conventional insulin therapy in critically ill infants & children.
The study was conducted on 30 infants and children
admitted to pediatric intensive care unit Ain shames university and divided into two groups.
The two groups of the study were divided as follows:
Group A: It included 15 patients (50%). We use insulin infusion to target their blood glucose to
normal fasting level (80-110 mg/dl) (tight glycemic control).
Group B : It included 15 patients (50%). We use insulin infusion to target their blood
glucose just below renal threshold (<180 mg/dl) (conventional control).
Then we assess the early outcome of tight glycemic control in comparison to conventional insulin
therapy in critically ill infants & children as regard mortality rate, occurrence of hypoglycemia,
length of stay in PICU, dependency on mechanical ventilation & vasoactive I.V drugs, organ failure,
secondary infection, measurement of base line CRP & 5 days after the intervention.
Results and data management:
1- Tight glycemic control significantly decrease mean blood glucose in comparison with
conventional control.
2- On studying the effect of intensive insulin therapy on mortality & morbidity(length of stay
in PICU, occurrence of hypoglycemia,, dependency on mechanical ventilation & vasoactive I.V
drugs, organ failure, secondary infection, measurement of base line CRP & 5 days after the
intervention)we found that tight glycemic control had no significant effect in comparison
with conventional control.
3- Although tight glycemic control significantly decrease mean blood glucose but didn’t increase
rates of hypoglycemia in comparison with conventional control.