Driver Brian E, Olives Travis D, Prekker Matthew E, Miner James R, Klein Lauren R
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota; Division of Pulmonary/Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
J Emerg Med. 2017 Dec;53(6):791-797. doi: 10.1016/j.jemermed.2017.08.068. Epub 2017 Oct 6.
Hyperglycemia is frequently encountered in the emergency department (ED), and insulin and intravenous fluid are commonly administered to reduce glucose prior to discharge.
We sought to determine the magnitude of the association between glucose-lowering therapies and 1) actual glucose reduction and 2) ED length of stay (LOS).
We performed a retrospective chart review study of patients with any glucose level ≥ 400 mg/dL who were discharged from the ED between January 2010 and December 2011. Generalized estimating equation models were created for the ED outcomes of glucose reduction and ED LOS with primary predictors of insulin and intravenous fluids administered.
The cohort consisted of 422 patients with 566 encounters. Median arrival and discharge glucose were 473 mg/dL and 326 mg/dL, respectively, with median glucose reduction of 144 mg/dL. Median length of stay was 253 min. After adjustment, 10 units of subcutaneous insulin and 1 liter of intravenous fluid were associated with 33 mg/dL and 27 mg/dL glucose reduction, respectively. Every liter of intravenous fluid administered was associated with a 45-min increase in ED LOS; insulin administration was not associated with ED LOS.
In patients with type 2 diabetes who present with moderate to severe hyperglycemia, both insulin and intravenous fluids are associated with a modest glucose reduction. Intravenous fluids were associated with a significant increase in ED LOS, but insulin was not. These results should be considered when determining whether to administer therapies that reduce glucose in the ED.
急诊科经常会遇到高血糖情况，在出院前通常会使用胰岛素和静脉输液来降低血糖。
我们试图确定降糖治疗与1）实际血糖降低以及2）急诊室住院时间（LOS）之间关联的程度。
我们对2010年1月至2011年12月期间从急诊科出院的任何血糖水平≥400mg/dL的患者进行了一项回顾性病历审查研究。针对血糖降低和急诊室住院时间这两个急诊室结局，建立了广义估计方程模型，以胰岛素和静脉输液的使用作为主要预测因素。
该队列包括422例患者，共566次就诊。到达时和出院时的血糖中位数分别为473mg/dL和326mg/dL，血糖中位数降低了144mg/dL。住院时间中位数为253分钟。调整后，10单位皮下胰岛素和1升静脉输液分别与血糖降低33mg/dL和27mg/dL相关。每输注1升静脉输液与急诊室住院时间增加45分钟相关；胰岛素的使用与急诊室住院时间无关。
在出现中度至重度高血糖的2型糖尿病患者中，胰岛素和静脉输液均与适度的血糖降低相关。静脉输液与急诊室住院时间显著增加相关，但胰岛素则不然。在确定是否在急诊科给予降低血糖的治疗时，应考虑这些结果。
