RESUMO
BACKGROUND: Hyperglycemia commonly occurs in critically ill patients, even in the absence of diabetes mellitus, and is associated with increased morbidity and mortality rates in such patients. METHODS: Medline search using the terms intravenous insulin, intensive care, myocardial infarction, cardiac surgery and stroke. RESULTS AND CONCLUSIONS: Intravenous insulin therapy with or without adjunctive subcutaneous insulin therapy has been shown to improve morbidity and reduce mortality rates in surgical intensive care populations compared with subcutaneous insulin alone or oral hypoglycemic therapy. The evidence for such is less compelling in medical intensive care populations. Intravenous insulin therapy alone or in combination with glucose and potassium infusion appears to improve clinical outcomes in cardiac surgery patients, but there is conflicting evidence concerning its effect on morbidity and mortality rates after myocardial infarction. Insufficient evidence exists to determine the effect of intravenous insulin therapy on outcomes in other populations including stroke patients, those undergoing major noncardiac surgery, and burn patients. Intravenous insulin nomograms and nurse-driven protocols may improve blood glucose control, resulting in improved clinical outcomes.
Assuntos
Estado Terminal/terapia , Hiperglicemia/tratamento farmacológico , Insulina , Glicemia/metabolismo , Procedimentos Cirúrgicos Cardíacos , Protocolos Clínicos , Humanos , Injeções Intravenosas , Insulina/administração & dosagem , Insulina/uso terapêutico , MEDLINE , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto , Resultado do TratamentoRESUMO
Orally-administered vancomycin is poorly absorbed in most patients, usually producing minimal or subtherapeutic serum concentrations. Bowel inflammation may enhance absorption of oral vancomycin, particularly in those with renal failure. A 77-year-old female with Clostridium difficile (C difficile) colitis and normal renal function was treated with high doses of oral vancomycin and achieved serum concentrations in the therapeutic range. To our knowledge, this is the first report of a patient with C difficile colitis and normal renal function to develop therapeutic serum concentrations following oral administration of vancomycin.