Incidence, cause and consequences of early hypoglycemia in severe trauma patients.

Wouters, M. (2013) Incidence, cause and consequences of early hypoglycemia in severe trauma patients. thesis, Medicine.

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Abstract

Introduction: Multiple trauma patients have increased energy needs caused by the injury and the subsequent systemic responses. Even in normally nourished persons glycogen stores may become inadequate after prolonged stress. Whether early hypoglycemia due to exhaustion might occur in trauma patients has not been studied before. Objectives: To determine the incidence and risk factors of hypoglycemia in severe trauma patients and relate this to potential contributing factors and subsequent outcomes. Methods: A retrospective database review was conducted on all adult trauma patients (age ≥ 16 years ) seen at our emergency department (ED) and subsequently admitted to the intensive care unit (ICU) between 1992-2011. The lowest glucose in the first 48 hours after the time of the accident was determined for all patients. Age, diabetes status, alcohol use, interval between accident and treatment at the emergency department, injury severity score (ISS), transfusion requirements and core temperature at the ED and ICU were recorded. Outcome measures including hospital mortality were also recorded, to determine the relation between glucose and mortality. The patients with an episode of hypoglycemia defined as any glucose ≤ 4.5 mmol/L in the first 48h after the accident were subsequently selected. These cases were then matched on age, sex and year of admission with an equal number of controls. Cases and controls were studied in detail. Also any calorie-containing infusions or feeding were administered. Results: A total of 2324 adult patients with mean±SD lowest glucose of 6.0±2.0 mmol/L and a hospital mortality of 22% were studied. Multivariable logistic regression analysis showed that glucose, age, ISS and transfusion requirements were all significantly related to hospital mortality. Moreover glucose also displayed a significant U-shaped relation with outcome (P< 0.001), thus underscoring that low early glucose levels are associated with mortality. 246 patients had a lowest glucose of ≤ 4.5 mmol/L and were matched with another 246 control patients. Diabetes status was univariately associated with low glucose levels (P=0.045) and alcohol use showed a trend towards low glucose levels (P=0.066). The interval between accident and ED-admission was not related with hypoglycemia, but core temperature measured at the ED and later at the ICU was significantly lower in hypoglycemic cases versus controls: 35.8±1.7 versus 36.2±1.1 ºC (P=0.007). Upon multivariable analysis, a lower core temperature remained associated with hypoglycemia (P=0.015). Conclusions: Early hypoglycemia can occur in severe trauma patients and is associated with increased mortality. The association of a low body temperature with hypoglycemia suggests insufficient metabolism as a common mechanism. Whether early administration of larger amounts glucose to selected trauma patients might provide benefit, deserves further study.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijsten, M.N.W. and Wendt, K.W.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:56
Last Modified:	25 Jun 2020 10:56
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1710

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