OBJECTIVEGlucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) have additive insulinotropic effects when coadministered in health. We aimed to determine whether GIP confers additional glucose lowering to that of GLP-1 in the critically ill.RESEARCH DESIGN AND METHODSTwenty mechanically ventilated critically ill patients without known diabetes were studied in a prospective, randomized, double-blind, crossover fashion on 2 consecutive days. Between T0 and T420 minutes, GLP-1 (1.2 pmol/kg · min−1) was infused intravenously with either GIP (2 pmol/kg · min−1) or 0.9% saline. Between T60 and T420 minutes, nutrient liquid was infused into the small intestine at 1.5 kcal/min.RESULTSAdding GIP did not alter blood glucose or insulin responses to small intestinal nutrient. GIP increased glucagon concentrations slightly before nutrient delivery (P = 0.03), but not thereafter.CONCLUSIONSThe addition of GIP to GLP-1 does not result in additional glucose-lowering or insulinotropic effects in critically ill patients with acute-onset hyperglycemia.
A 24-hour infusion of triiodothyronine, with or without hydrocortisone, in an ovine model of septic shock did not markedly alter norepinephrine requirement or any other physiological parameter.
Objective
To determine the relationship between arterial and venous acid–base status in a model of septic shock.
Methods
Paired samples (n = 435) of arterial and femoral venous blood from 57 sheep (47 septic, 10 non‐septic) managed with protocol‐guided ventilation, sedation, parenteral fluids and inotropic support.
Results
The arterial‐venous difference in acid–base parameters was similar with and without sepsis. There was a consistent arterio‐venous relationship for metabolic (pH, lactate, bicarbonate, base excess), but not respiratory parameters (partial pressures of oxygen, carbon dioxide, and haemoglobin‐oxygen saturation), independent of sepsis.
Conclusions
Venous blood provides a reliable measure of metabolic but not respiratory disturbance.
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