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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