Intensivmedizinische Aspekte des Blutzuckerstoffwechsels

Blutzuckerentgleisungen und ihre Folgen sind ein häufiger Befund in der Intensivmedizin. Die Stresshyperglykämie ist dabei ein relevanter Faktor in der Mortalität vor allem nicht entsprechend präkonditionierter Patienten. Die Behandlung von Ketoazidose und hyperosmolarer Entgleisung ist erfahrenen Behandlern vorbehalten. Wesentlich für die Patientensicherheit sind feste Standards in der Therapie dieser kritischen Stoffwechselzustände. Erschwert wird die Blutzuckerkontrolle in der Intensivmedizin durch einflussnehmende Medikation und enterale/parenterale Ernährung.

Kernaussagen

• Im intensivmedizinischen Setting ist in der Regel ein Blutzuckerkorridor von 140–180 mg/dl sinnvoll und sicher.

• Der kritisch kranke Patient zeichnet sich häufig durch eine entgleiste Blutzuckersituation aus, dies ist besonders dann prognostisch bedeutsam, wenn ein Diabetes mellitus nicht vorbekannt ist.

• Die Bedeutung einflussnehmender Medikation (Katecholamine, Glukokortikoide) sollte in der Therapie entgleister Blutzuckerwerte frühzeitig mitbedacht werden.

• Die Ketoazidose nimmt in ihrer Häufigkeit zu. Therapeutisch steht die Insulintherapie im Vordergrund.

• Bei hyperosmolaren Entgleisungen ist die Volumentherapie führend.

• Die enterale ist der parenteralen Ernährung vorzuziehen. Die Anpassung von Kalorienzufuhr und Insulindosierung ist hierbei ein dynamischer Prozess.

Schlüsselwörter

Intensivmedizin - Ernährung - Diabetes mellitus - Insulinbedarf - Stoffwechselentgleisung - Hyperglykämie - Hypoglykämie

Publikationsverlauf

Artikel online veröffentlicht:
24. Mai 2022

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