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Critical care clinics · Jan 2018
ReviewEndocrine and Metabolic Alterations in Sepsis and Implications for Treatment.
- Catherine Ingels, Jan Gunst, and Greet Van den Berghe.
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, Leuven 3000, Belgium.
- Crit Care Clin. 2018 Jan 1; 34 (1): 81-96.
AbstractSepsis induces profound neuroendocrine and metabolic alterations. During the acute phase, the neuroendocrine changes are directed toward restoration of homeostasis, and also limit unnecessary energy consumption in the setting of restricted nutrient availability. Such changes are probably adaptive. In patients not recovering quickly, a prolonged critically ill phase may ensue, with different neuroendocrine changes, which may represent a maladaptive response. Whether stress hyperglycemia should be aggressively treated or tolerated remains a matter of debate. Until new evidence from randomized controlled trials becomes available, preventing severe hyperglycemia is recommended. Evidence supports withholding parenteral nutrition in the acute phase of sepsis.Copyright © 2017 Elsevier Inc. All rights reserved.
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