Hyperglycemia associated with parenteral nutrition in noncritical patients

Abstract

Background: Hyperglycemia is common in hospitalized patients and is a marker of poor prognosis. The aim of this study was to determine the prevalence of hyperglycemia during the administration of parenteral nutrition (PN) in non-critically ill patients, and to identify the associated predictive risk factors. Methods: Observational study of a retrospective cohort based on the records of 120 hospitalized patients who received PN for five or more days. Results: 63.3% presented hyperglycemia (>140 mg/dl), of which 35.8% were major hyperglycemia (>180 mg/dl). The prescription of energy needs was based on the Harris-Benedict equation, none case was the oxidation rate of each macronutrient exceeded. All patients received adequate glucose monitoring during administration of PN. Risk predictors for hyperglycemia were IQ > 25 kg/m2 (OR 1,260, 95% CI 0.965–1.645, p = 0.03), history of Type 2 Diabetes Mellitus (OR 1.532, 95% CI 1222–1,919, p = 0.02), use vasoactive amines (OR 1,478, 95% CI 1145–1,907, p = 0.04), systemic steroids (OR 1,603, 95% CI 1392–1,845, p = 0.05) and infection (OR 1,169, 95% CI 0.845–1,618, p = 0.05). Hyperglycemia was significantly associated with longer duration of PN, higher triglyceride levels and higher doses of vasoactive amines. Conclusions: Hyperglycemia in non-critically ill patients receiving PN is higher. The risk predictors for hyperglycemia identified in this study were BMI >25 kg/m2, a previous history of DM2, the use of vasoactive amines, the use of systemic steroids, and the presence of infection. These results reinforce the need to identify risk factors and implement glycemic control protocols in patients receiving PN.

Keywords

• Hyperglycemia
• Parenteral nutrition
• Non-critical patients