No abstract

Therapeutic study, level IV.

Tetracyclines, including doxycycline, are widely used drugs that form an integral part of daily prescribing, and serious adverse reactions (SARs) are rarely reported. The frequency of hypoglycaemia complicating tetracycline treatment remains unknown, and is not a recognized complication. We describe an 80-year-old man with a history of insulin-dependent diabetes who was recruited into a large research study, and subsequently experienced the unexpected SAR of hypoglycaemia following treatment with doxycycline.

This chapter focuses on hyperglycemia after cardiac surgery, which is an independent predictor of morbidity and mortality, regardless of a history of diabetes. Acute hyperglycemia is common in the cardiac surgical perioperative period. Although many hyperglycemic patients undergoing cardiac surgery carry a preexisting diagnosis of diabetes mellitus, a significant portion will have either undiagnosed diabetes or insulin resistance. Other cardiac surgical patients may be non-diabetic but hyperglycemic due to the stress response related to surgery. This “stress hyperglycemia” is generally defined as a transient increase in blood glucose levels that develops during illness in a non-diabetic patient. A preadmission glycosylated hemoglobin (HbA1c) level measurement is helpful in distinguishing patients with stress hyperglycemia from those with undiagnosed diabetes mellitus and thus guide postoperative management. Patients with elevated HbA1c levels may need further interventions in order to optimize perioperative glycemic management pre-, intra-, and postoperatively. The chapter then details the Society of Thoracic Surgeons clinical practice guidelines and recommendations concerning perioperative glucose control.