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Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients

Slob, EMA; Shulman, R; Singer, M; (2017) Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients. Journal of Critical Care , 41 pp. 72-77. 10.1016/j.jcrc.2017.04.039. Green open access

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Abstract

Purpose To audit the use of GIK in terms of safety, haemodynamic effects, and impact on catecholamine dosage. Materials and methods A retrospective, descriptive, evaluative audit of GIK use within the adult ICU of a London teaching hospital was conducted. Rescue therapy of GIK (up to 1.0 Units insulin/kg/h) was administered to improve cardiac function. Outcomes were ICU survival, change in cardiac index (CI) and blood lactate levels, events of hypoglycaemia, hyperglycaemia, hypokalaemia and hyperkalaemia, and discontinuation time of catecholamine inotropes. Results Of 85 patients treated with GIK, 13 (15.3%) survived their ICU stay and 9 (10.5%) were discharged home. In patients surviving until 72 h, a trend of improved CI and lactate levels was seen, often with reductions in catecholamine dosing. Inotropes were discontinued in 35 (54%) patients. Severe hypoglycaemia (< 2 mmol/l), hyperglycaemia (> 20 mmol/l), hypokalaemia (< 2.5 mmol/l) and hyperkalaemia (> 7 mmol/l) during GIK affected 1, 6, 8 and 1 patients, respectively. These abnormalities were quickly identified. No measurable harm was noted. Conclusions High-dose GIK can be safely used in critically ill patients, though blood glucose and potassium levels must be monitored frequently. GIK was associated with improved CI and blood lactate levels. Impact on survival requires prospective evaluation.

Type: Article
Title: Experience using high-dose glucose-insulin-potassium (GIK) in critically ill patients
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.jcrc.2017.04.039
Publisher version: https://doi.org/10.1016/j.jcrc.2017.04.039
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Critical Care Medicine, General & Internal Medicine, GIK, Critically ill, Insulin, Glucose, Potassium, Intensive care, ACUTE MYOCARDIAL-INFARCTION, RANDOMIZED CONTROLLED-TRIAL, HEART-FAILURE, CARDIAC-SURGERY, THERAPY, MORTALITY, INOTROPES, INFUSION, BLOCKER, SHOCK
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10043198
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