Sepsis and glucose

Q: Severe sepsis results in? (select one)

A) hypoglycemia

B) hyperglycemia

Answer: A

Hypoglycemia is common in ICU. Factors commonly associated with hypoglycemia in ICU are underlying diabetes, kidney dysfunction, mechanical ventilation, high APACHE score, and severe sepsis or shock. One of the major reasons for hypoglycemia in ICU is the over-enthusiasm to achieve tight glucose control. 

As sepsis progresses, increased cytokines cause glucose utilization. Once utilization exceeds glucose production, hypoglycemia occurs. This is further complemented by cytokine-induced inhibition of gluconeogenesis. Another contributing factor in severe sepsis is ischemic liver (shock liver) leading to hypoglycemia.

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References: 

1. Krinsley JS, Grover A. Severe hypoglycemia in critically ill patients: risk factors and outcomes. Crit Care Med 2007; 35:2262. 

2. Maitra SR, Wojnar MM, Lang CH. Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis. Shock 2000; 13:379.