OBJECTIVE: To determine patterns of hyperglycemic (HG) control in acute stroke. METHODS: Anonymous survey through Internet questionnaire. Participants included Latin-American physicians specialized in neurocritical care. RESULTS: The response rate was 74%. HG definition varied widely. Fifty per cent considered it when values were >140 mg/dL (7.8 mmol/L). Intravenous (IV) regular insulin was the drug of choice for HG correction. One fifth of the respondents expressed adherence to a protocol. Intensive insulin therapy (IIT) was used by 23%. Glucose levels were measured in all participants at admission. Routine laboratory test was the preferred method for monitoring. Reactive strips were more frequently used when monitoring was intensive. Most practitioners (56.7%) monitored glucose more than two times daily throughout the Intensive Care Unit stay. CONCLUSIONS: There is considerable variability and heterogeneity in the management of elevated blood glucose during acute phase of stroke by the surveyed Latin-American physicians.
com.ar L a prevalencia de los estados poliúricos en sujetos con injuria cerebral aguda es desconocida, pudiendo presentarse como consecuencia del daño neurológico per se o por la terapéutica adoptada 1-4 . Poliurias pueden tener impacto negativo sobre el cerebro injuriado, a través de hipovolemia, hipotensión arterial y cambios en la osmolaridad. Implica un verdadero reto diagnóstico-terapéutico 5,6 ; por ello, un rápido reconocimiento y adecuado análisis, permitirá instaurar la conducta más apropiada. Los estados poliúricos están relacionados con desequilibrios hidroelectrolíticos, (principalmente del contenido de sodio) y trastornos de la osmolaridad 7-10 , situaciones que contribuyen a agravar y perpetuar el daño inicial 11 . Este trabajo pretende en forma práctica y sencilla aportar un enfoque que nos permita reconocer los estados poliúricos, identificar sus causas y analizar la manera más adecuada de tratarlos.
Primer paso: ¿cómo definimos poliuria?Poliuria deriva del griego "poly" (mucho); ouro (orina) 12 . Se define de diferentes maneras: a) > 3.000 cc diarios; b) > 150 ml/h; c) > 3 ml/kg/h, o d) diuresis mayor a 10 ml/min [5][6][7][8][9][10] . Sus causas son variadas al igual que su duración, pudiendo estar ocasionadas por la injuria cerebral o por intervenciones terapéuticas: reposiciones de volumen, utilización de agentes osmóticos (manitol, salino hipertónico), diuréticos, nutrición parenteral.
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